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EPIDEMIC CHOLERA. 



ALL THE MATERIAL FACTS 



IN THE 

HISTORY 

OF 



EPIDEMIC CHOLERA: 



BEING 



A REPORT 



OF THE 



COLLEGE OF PHYSICIANS 

OF PHILADELPHIA, 



mm m&m m wmimi 



AND 

A FULL ACCOUNT OF THE CAUSES, POST MORTEM APPEAR- 
ANCES, AND TREATMENT OF THE DISEASE. 

BY JOHN BELL, M. D. 

Lecturer on the Institutes of Medicine and Medical Jurisprudence, Fellow of the College of Phy- 
sicians, one of the Vice-Presidents of the Medical Society of Philadelphia, Senior 
Physician to the Philadelphia Dispensary, &c. &c. 

AND 

BY D. FRANCIS CONDIE, M. D. 

A Corresponding Secretary of the Philadelphia Medical Society, one of the Out-Door Physicians 
to the Philadelphia Alms House, &cc. &c. 

,ry of Cc,:-.^ 

— ••>►>© © ©""* ' j p ,<s ^w 

i a 

iihtlatieljihta: Wash* 

PUBLISHED BY THOMAS DESILVER, Jim. 

No. 247, Market Street. 



Clark ty Raser, Printers, 60 Dock Street, 
1832. 



£ 






a, 



Entered according to Act of Congress, in the year 1832, by Thomas Desil- 
ver, Jun., in the Clerk's Office of the District Court, for the Eastern District of 
Pennsylvania. 



TO THE READER. 

The Report of the College of Physicians of Phila- 
delphia, of which the Publisher has obtained the copy- 
right, contains a full but succinct history of the circum- 
stances worthy of note, in regard to the geographical 
range and localities of Cholera, and the classes of persons 
chiefly attacked — as well as abundant and convincing 
proofs of the non-contagiousness of the disease, and of 
the utter uselessness of quarantine restrictions. It is 
terminated with clear Sanitary Precautions, pointing 
out the means of prevention, by a rational system of 
hygiene, adapted to place, habitation, and person. 
The Report contains nearly all that more especially 
concerns the general reader and public at large; and 
serves as an appropriate introduction to the work it- 
self. For preparing this, the Publisher was glad to avail 
himself of the services of Drs. Bell and Condie, the 
first, the recognized author of the Report ; and who had 
collected much valuable matter on the subject — the 
second, whose store of facts was very rich, particular- 
ly in those obtained from the writings of the German 
Physicians on Cholera. The result of the joint labours of 
these gentleman will, the Publisher confidently believes, 
contain a fuller and more impartial digest of the medical 
practice in Cholera, and of the symptoms and modify- 
ing circumstances, from the appearance of the disease 
in Bengal in 1817, down to the present time, than any 
one work which has hitherto been published. 



CONTENTS. 



REPORT OF THE COLLEGE OF PHYSICIANS. 

Geographical Range, and Order of Succession in which Cholera made its 
attack in different countries and cities. — Atmospheric and other Phenomena 
anterior to and contemporaneous with the prevalence of the Disease. — 
Localities of Cholera, in India, Persia, Russia, Poland, Germany, Great 
Britain and France. The Classes of People and Mode of Living of those 
who have died in the greatest numbers. — Means of preventing the Exten- 
sion and mitigating the Violence of Cholera. — Inutility of Quarantines in 
all the chief Cities of Europe, which were visited by the disease. — It origi- 
nated spontaneously in each of those Cities. — The Cholera is not transmis- 
sible by Persons or Goods. — Is not Contagious. — Means of Prevention — 
by Sanitary Regulations — as regards Place, Habitation, and Person. — Ad- 
vantages of temperance and care in warding off the Disease. Page 5 — 37. 

CHAPTER I. 

Of the Origin of Cholera. — Is common as an Endemic Disease. — Illustration 
of Endemics, in the instance of Remittent and Intermittent Fevers. — Of 
the Difference between Endemic and Epidemical Diseases. — Further ex- 
ample of Epidemic Disease in Influenza. — Causes of Epidemic Diseases. — 
Deteriorated air, affecting other animals besides man, also fruits, and vege- 
tation generally. — Intstances of stagnant air occurring as a cause of Pesti- 
lence. — Defective and bad Food a cause of Epidemic Disease. — Influence 
of Civilization. — Examples of Destructive Epidemic Diseases in Greece 
and Rome, during the middle ages, and in later times, in different parts of 
the world. — The Plague is of home or spontaneous origin in a place, as 
proved to be in Dantzic and Marseilles. — Prevailed fn Northern Europe 
long before commercial intercourse with the Levant. — The Cholera equal- 
led in its range and exceeded in its mortality by preceding Pestilences. — 
Even in its present or Epidemic form it is not a new Disease. Is mentioned 
by Bontius, Paisley, Sonnerat, Curtis, Girdlestone, and others, as prevail- 
ing at different times in Hindostan, and by Sydenham in England. — Is En- 
demic in the United States Page 37 — 48. 

CHAPTER II. 

The first cause of Cholera is not known. — It is at any rate chiefly dangerous 
by the aid of the common causes of disease. — Atmospheric changes preced- 
ing the appearance of Cholera — Influence of localities and modes of living 
on the production of the Disease. — Means of prevention stated. — Quaran- 
tine and similarly restrictive measures utterly useless, and always injurious. 
— Cholera is not Contagious. — It is not transmissible by Persons or Goods. 

Page 48—56 



IV CONTENTS. 



CHAPTER III. 

Symptoms of common Cholera. — Alleged but not proved difference between 
the essential characters of this and Epidemic Cholera. — Symptoms of 
the latter. — Great importance of attention to the premonitory symptoms 
of Epidemic or Spasmodic Cholera. — Among the chief of these, consti- 
tuting a disorder in itself, is Diarrhoea. — Functions chiefly disturbed by 
Cholera. — Second, or febrile stage of the Disease, being the re-action fol- 
lowing depression and collapse. Page 56 — 72. 

CHAPTER IV. 

Of the morbid Appearances detected in the Bodies of those who have died of 
Cholera. Page 72—77. 

CHAPTER V. 

Treatment of Cholera; when in time, it is not an unmanageable Disease. — 
Blood-letting. — Sinapisms and Rubefacients. — Dry Frictions. — Blisters. — 
Dry Heat. — Warm Bath. — Calomel. — Opium. — Internal Stimuli. — Emetics. 
— Purgatives. — Enemata. — Sub-nitrate of Bismuth.— ^-Muriate of Soda. — 
Drinks. — Secondary Stage. — A sketch of the Several Stages of Cholera, 
with an Account of the Treatment adapted to each of these Stages. 

Page 77—104. 

APPENDIX. 

Early Notices of Epidemic Cholera in India, Page 105 — 118. 
Deaths from Cholera for the last ten years in Philadelphia, 118. 
The Use of Tobacco Enemata in Cholera, 118—120. 
Sketch of the Practice of three Eminent Practitioners of Newcas- 
tle, in Cholera, 120—122. 
Of the Treatment of Cholera in India, 222—124. 
Of the Treatment of Cholera in Paris, 124—126. 
Premonitory Symptoms and Precautions against Cholera, 126 — 127 



REPORT, &c. 



The Committee of the College of Physicians, appointed to 
institute an impartial examination into the facts in relation to 
the Epidemic Cholera, in conformity with a request for infor- 
mation on this subject from the Board of Health, beg leave to 

REPORT, 

That after frequent meetings, and a free interchange of sen- 
timents, among themselves, respecting the manner in which 
they could best meet the wishes of the Board of Health, and 
fulfil the duty devolved on them by the College, they have 
thought that a plain narrative, chiefly consisting of the essen- 
tial facts connected with the origin and spread of Cholera, 
would be the most instructive in itself, and furnish the best 
data for the measures of sanitary precaution with which the 
Committee close their report. This narrative will be given 
under the following heads: — 

I. The geographical range of Cholera, and the order of suc- 
cession in which different countries, districts, and cities, have 
suffered from the disease. 

II. The atmospheric and other phenomena preceding and ac- 
companying its prevalence. 

III. The localities in which the disease has chiefly prevailed 
and proved most destructive. 

IV. The classes of people, and the modes of living of those 
who have died in the greatest numbers. 

After detailing the chief facts and circumstances under these 
various heads, the Committee proceed to inquire into the means 
of preventing the extension, and mitigating the violence of the 
disease, should it appear amongst us. In this division of the 
subject, they examine into the reasons of those who had hoped 
for absolute protection from the disease, by non-intercourse 
with all places where it was prevailing. The Committee can 
find no valid cause for such a belief. Their inquiries, hereafter 
detailed, have satisfied them that all attempts by insulation and 
non-intercourse, by means of sanitary cordons, and the most 
rigid quarantine, to exclude the disease, have signally failed in 



6 

every country and city in Europe, however well devised and 
skilfully and energetically executed. The disease has sprung 
up in the heart of a city, and chosen for its first victims per- 
sons who had no intercourse with sickly places or persons. It 
is further shown that free communication between the sick of 
Cholera and the healthy, has not endangered the latter, or in- 
creased their probabilities of an attack. The Committee con- 
clude their report by a recommendation of such sanitary regu- 
lations in reference to place, habitation, and person, as expe- 
rience has clearly pointed out. 

/. Geographical Range, and Order of Succession in which the Cho- 
lera made its Attacks in different Countries and Cities. 

1. Geographical Range. — Most of the historians of Chplera de- 
scribe it as first showing itself in Jessore, a town 62 miles north- 
east of Calcutta, about the middle of the month of August, 1817. 
But it is known that its appearance in this last mentioned city 
was nearly contemporaneous, nay, some say anterior to its break- 
ing out in Jessore. It is distinctly affirmed in the Bengal Me- 
dical Reports, that the disease appeared in the Nuddeah and 
Mymuni districts in May, 1817, raged extensively in June, and 
in July reached Dacca. Before the end of November, few towns 
or villages in an area of several thousand miles escaped an at- 
tack. Across the whole extent of the Gangetic Delta, and es- 
pecially in the tracts bordering the Hoogly and Jellinghy ri- 
vers, the mass of the population was sensibly diminished by 
the pestilence. It is needless to describe minutely in this place 
the ravages of the Cholera in the various towns and districts of 
Hindostan. These were in one direction along the Ganges and 
its tributary streams. Delhi, the ancient capital of that coun- 
try, on the western bank of the Jumna, was attacked in July, 
1818. The disease appeared in Bombay, on the western coast, 
in August, and in Madras, on the eastern coast of the penin- 
sula, in October, 1818. In Trincomalee, in the island of Cey- 
lon, it was first noticed in December of the same year. Since 
1817, Calcutta has been a regular sufferer from Cholera every 
season. The same remark will apply to Bombay, and with 
the exception of two years, to Madras. 

In 1820, we find the Cholera to have shown itself in Cochin 
China, Tonquin, and the Philippine Islands, and at the conclu- 
sion of the year was in Canton, and the southern part of China 
Proper. Pekin, the capital, was assailed in successive years, 



and in Chinese Tartary, Cholera appeared at two different 
times, with a considerable period intervening. In the island of 
Java, it broke out in April, 1821, and in the Molucca Islands, 
and in Canton for the second time, in 1823. In July, 1821, it 
showed itself at Muscat on the southern end of the Persian 
Gulf, and in the same year at Bassorah and Bagdad. Persia 
has been subjected to its ravages five different times from 1821 
to 1830. In 1822, the disease was raging in Mesopotamia and 
Syria, having appeared as far west as Tripoli, on the shore of 
the Mediterranean Sea, and in the year 1824, at Tiberias, in 
Judea, on the same coast. 

In September, 1823, the disease showed itself in Astracan, a 
large and populous town at the mouth of the Volga, on the 
northern shore of the Caspian Sea. But it soon subsided 
here, and did not break out again in any part of the Russian 
Empire until the close of the year 1829, when the town of 
Orenberg was attacked. On the last of July, 1830, it again ap- 
peared in Astracan, in which city and province the mortality 
was this time excessive. Near the close of September, of the 
same year, it was announced as prevailing in Moscow, and in 
June, 1831, in St. Petersburgh and Archangel. Riga and 
Dantzic had begun to suffer from the pestilence in May of the 
same year. Its presence was discovered among the wounded 
and prisoners, who had been conducted to Praga, a suburb of 
Warsaw, but separated from that city by the Vistula. On the 
same day it appeared in the Polish army, after the battle of 
Inganie. Hungary was the theatre of its operations in August, 
of the same year (1831). In Berlin and Prussia it appeared in 
August, in Vienna in September, and in Hamburgh, in Octo- 
ber, of that year. 

The first place attacked in England by the Cholera, was 
Sunderland, a sea-port town in the county of Durham. The 
disease had appeared there as early as August, 1831, but did 
not engage general attention or excite alarm, until the latter 
part of the year. Since then, it has manifested itself in New- 
castle-upon-Tyne, and many other contiguous places in the 
north of England; and in Haddington, Edinburgh, Glasgow, 
and other towns in Scotland. It showed itself in London 
during the last winter, and in the spring in Dublin, Belfast, 
Cork, and other places in Ireland. In the early part of April, 
its presence was announced in Paris, and since then it has ap- 
peared not only in the small towns around that capital, but in 
many other places in France. 



8 

2. Order of Succession in which different Countries and Districts 
have suffered from Cholera. — The disease during the year 1817, 
that in which it first appeared in many different parts of Ben- 
gal, was mainly restricted to this province. It ceased to pre- 
vail any where on the approach of winter of that year. Up to 
this time the most southerly point along the coast, stretching 
to the south and west, which was attacked, was Cuttack, and 
that to the north and east, (taking Calcutta as the centre) 
was Silhet. 

In the following year, 1818, the order of succession was re- 
markably regular — a month interval for every degree of lati- 
tude. Ganjam, which is in 19° and some miles, north latitude, 
was attacked on the 20th March; and Madras, in north lati- 
tude, 13°, October 8th. This was the rate during the dry sea- 
son, and when there was no interference with the constant com- 
mercial intercourse which prevails on the Coromandel Coast. 
From Madras south, the order of succession was in an accele- 
rated degree. It is worthy of remark here, that for two months, 
beginning on the 10th of October, the port of Madras is annu- 
ally closed, and in consequence of the prevailing winds, and of 
the surf, which, during this period breaks upon the whole 
of that open coast, every vessel is forced to leave it, and the 
small trading vessels are drawn high and dry on land. Yet 
still, as just remarked, the places to the south were assailed by 
the disease even in more rapid succession than those to the 
north of this city. 

Not very dissimilar was the order of succession in which 
places in the interior of the peninsula were attacked — so that ' 
the disease appeared nearly simultaneously at the sea-port of 
Madras, and in places on parallel latitudes, in the interior. At 
Masulipatam, a town on the Coromandel Coast, and situated 
near the mouth of the Kistna river, the disease showed itself on 
the 10th July, 1818; and at Punderpoor, on one of the head 
branches of this river, in a W. N. W. direction, and distant 
some hundred miles, it appeared on the 14th of the same month, 
while intervening places were affected at a later period. Bel- 
lary, in the centre of the peninsula, in latitude 15°, was attacked 
on the 8th September. Nellore, on the eastern coast, was first 
a sufferer, on the 20th of the same month — so that we can 
not conceive of any direct progression of the disease, or of any 
substantive cause of it passing from the coast to the interior, nor 
from the interior to the coast. The long interval also between the 
appearance of the disease at Cuttack, by the last of September, 



9 

1817, and at Ganjam on the 20th of March, 1818, forbids our 
supposing the transmission of any known substantive cause of 
the disease from^one of these places to the other — both being 
situated on the coast, and within a moderate distance of each 
other. Aska, near Ganjam, in the interior, and on the main 
route south-west from Cuttack, was not visited by the disease 
till the 23d April, 1818. 

In China, we find that the disease one season attacked places 
in succession in a south-easterly direction from Tartary to 
Pekin, and at another time assailed them in a north-west course 
from Canton to Pekin. Persia was attacked in different years 
by Cholera, and the order of succession and direction not regu- 
lar. From Bassorah on the head of the Persian Gulf, through 
Mesopotamia to Aleppo, and along the coast of Syria to Da- 
mascus, the direction was north-west — but the attacks were not 
in any very marked order — the period between its being in Bas- 
sorah and in Damascus, was four years. A caravan would tra- 
verse the same space in nearly as many months. Egypt, conti- 
guous to Syria, and holding regular intercourse with it both by 
sea and land, did not suffer from the Cholera until eight years 
after its appearance in Antioch and Tripoli, a Syrian sea-port, 
and nine after its attacking Aleppo. 

During the month of May, 1831, the Cholera broke out in 
Mecca and other places in Arabia, and in the month of August 
in Cairo and Alexandria, in Egypt. The disease was in As- 
tracan, at the mouth of the Volga, on the Caspian Sea, in Sep- 
tember^ 1823. No places to the north and west were sufferers 
from the disease either on this or the following years, until the 
month of July, 1830, when it reappeared in Astracan. From 
this time, until the beginning of winter, a great portion of Rus- 
sia in Europe was attacked with Cholera; but in following a 
given line from Astracan, along the banks of the Volga, in a 
north-west course, we cannot find any regular order of succes- 
sion of attacks of towns and villages. Thus, Astracan, at the 
mouth of the river, was, as we have seen, the seat of the pesti- 
lence in July, 1830. Saratov, higher up, and Novgorod, some 
hundred miles still farther up the stream, suffered in August of 
the same year, while Samara, situated between them on the 
Volga, had no Cholera all October. Asof, at the mouth of the 
Don, was attacked in October, whilst the region of country to 
the north and west, and on as far as Moscow, suffered from the 
disease in September. Kiow, on the Dnieper, felt its ravages 
in October, 1830, whilst Brody, on the south-west, had not the 



10 

disease until May, 1831. On the Baltic, we meet with similar 
irregularities. In Riga, the disease prevailed in May; in Mit- 
tau, to the south, in June; in Liebau, more southerly, in May; 
and in Polangen, still farther south along the same line of coast, 
in June. If, again, we take a city on the extreme eastern boun- 
dary, as Orenberg, for example, we discover that the disease 
prevailed there in September, 1829, and a year elapsed before 
places on the great roads, to the west or interior of the empire, 
were affected. Archangel and St. Petersburgh, the first on the 
White Sea, the second on the Gulf of Finland, were both the 
seats of the disease in the same month, (June) 1831, while Va- 
logda, directly in the line of water or commercial communica- 
tion, was a sufferer in September of the year before, or 1830. 

The Cholera appeared in Warsaw in April; in Dantzic in 
May; in Pest, (Hungary) on the Danube, in July; in Vienna, 
higher up the river, in September. In Berlin, it broke out in 
the last of August; whilst Thorn, more to the east, and hold- 
ing direct intercourse with Warsaw and Dantzic, escaped. 
In Hamburg it appeared in October. Whatever line we may 
assume, we cannot observe any regular order of succession in 
which the different cities were attacked — either along rivers, 
or on the great high roads between capital cities. In Russia, 
Prussia, and Austria, where the greatest efforts were made to 
set limits to the disease by sanitary cordons, and the most rigid 
system of quarantine, the periods between the attacks of cities 
and districts, were not any longer than in India, where the most 
unrestrained intercourse by sea, and along the rivers and roads, 
was allowed. Any line by which we should pretend to mark 
the places attacked by the Cholera, must be very irregular — 
sometimes approaching a town or village, and then passing 
round it — to return after the lapse of weeks or even months. 
Sometimes the disease would nearly depopulate small villages 
near a principal station, before it made its appearance there. 
It is worthy of remark, that at the very time when the western 
part of Russia and Poland, and parts of Germany, were suffer- 
ing from the Cholera, it raged with great violence in Arabia 
and Egypt. 

Perhaps we could not cite a stronger example of the diffi- 
culty of explaining by any known law of transmission or order 
of succession, an attack of Cholera, than its sudden appear- 
ance in the heart of Paris — the first city in France to suffer 
from the pestilence. 

The annals of Cholera prove that when it made its appear- 



11 

ance in a camp or a city, far from extending to every habita- 
tion, it was almost invariably confined to particular portions of 
even the most populous places. Sometimes in an army, for in- 
stance, one or two regiments encamped together, or separated 
by other corps, were the. only sufferers in an attack of the dis- 
ease; one division in one street only of a town, had the disease 
existing in it — nay, its presence has been known to be limited 
to one side of a market place. Removing a camp a few miles, 
has frequently put an entire and immediate stop to the occur- 
rence of new cases; and when the disease prevailed destruc- 
tively in a village, the natives often got rid of it by deserting 
their houses for a time, though, in so doing, they necessarily 
exposed themselves to many discomforts, which would com- 
monly be considered as exciting causes of disease. 

It has been said, that the course in which the Cholera has 
successively appeared, has been westwardly. This is an error, 
if we have regard to the chronological order in which it has 
made its attacks, or assume any place as a point or beginning, 
from which the disease may have been supposed to diverge. 
Thus, in the year 1823, we find the Cholera to have shown it- 
self as many degrees eastward of Calcutta—viz. the islands of 
Banda and Timor — as it had done westward, or on the shores 
of Syria and Judea — Nor has the line of its progress been either 
north-west or north-east. 

II. Atmospheric and other Phenomena anterior to and contempo- 
raneous with the prevalence of the Disease. 

Many of the British physicians and surgeons in India, de- 
scribe frequent and great deviations from the usual order of the 
seasons, before and during the existence of Cholera; and they 
speak of unusually violent thunder storms, " violent squalls," 
and storms of wind and rain. Earthquakes were also felt in 
various parts of Hindostan. At the time when the grand army 
under the Marquis of Hastings suffered so dreadfully from the 
disease, the thermometer ranged from 90 to 100° — the heat was 
moist and suffocating, and the atmosphere a dead calm. 

The origin of the disease at Calcutta has been attributed to 
the extreme heat and drought of the season, followed by heavy 
rains, and the use of unwholesome food, viz : bad sable fish and 
ouze, or new rice. In the island of Java the weather, when the 
Cholera broke out, (April) was represented as unusually dry 
and hot. 



12 

At Bombay the fall of rain was unusually great in August, 
1818, in the latter part of which month the disease broke out. 
The same remark was made of the weather at Madras. It was 
observed that the different attacks of the epidemic in General 
Smith's force at Seroor, and other places, were always accom- 
panied by a cloudy, overcast state of the sky, sudden showers, 
composed of large drops of rain, resembling those of a thun- 
der storm, and a thick, " heavy" state of the air, giving it a 
whitish appearance! and whenever the weather cleared up, the 
disease disappeared. The person (an intelligent officer) who 
makes the above remarks, also observed that the disease was 
invariably preceded and accompanied by a large black cloud 
hanging over the place; and added, that this had been univer- 
sally remarked, and that the appearance had even received the 
name of the Cholera cloud. 

Similar notices abound of the connexion between the dis- 
turbed state of the weather and the appearance of the disease 
in various parts of India. It was also a subject of very general 
remark, that the prevalence of southerly and easterly winds, 
seemed to give vigour and force to the disease, while a change 
to the north and west, and a dry and pure atmosphere, it 
almost uniformly subsided. However aggravated the disease 
was in the summer months, or rather from spring to the be- 
ginning of winter, it was most generally quiescent in this latter 
season, in India. 

It would seem, however, that of all the atmospherical phe- 
nomena, which have been alleged to accompany the disease, 
none are universally present, except those which indicate a 
diminution in the density of the air, and a tendency to rain and 
storms. In other words, the atmosphere, during the prevalence 
of the disease, is in a rarefied state; and exhibits a great ten- 
dency toTpart with its moisture, forming thick clouds, heavy 
rain, or haziness; and to become agitated by storms. It has 
been further said, but not generally confirmed, that the mete- 
orological occurrences which have been observed to accompany 
the disease, are either produced by, or attended with, a dimi- 
nution of the quantity of free electric fluid in the atmosphere. 

The influence of season on the appearance and virulence of 
the disease in Persia arid Turkey is thought to be as evident as 
in India; for we learn, that during the three years, in which it 
prevailed in succession at various places from the shores of the 
Persian Gulf to the Mediterranean, in one direction, and to 



13 

the borders of Russia in Europe, in the other, it prevailed only 
in summer. 

The weather, before the breaking out of the Cholera in 
Mecca, (in 1831) was remarkable for the excessive heat — the 
thermometer being steadily as high as 102° F., and afterwards 
heavy rains, with the wind from the south and south-east. 

Before the appearance of the disease in Suez, a very hot south 
wind prevailed. 

At Cairo, during the first period of the disease, the wind 
was from the north-east, and the heat, during the day, suffo- 
cating. 

At Nishni Novogorod in Russia, there suddenly succeeded to 
a warm and dry state of the atmosphere, in the month of Au- 
gust, 1830, a continuance of cold and wet. At this time the 
Cholera began. Prevailing winds south-east. 

The Cholera appeared in Riga at the commencement of un- 
commonly hot and sultry weather. 

In Poland the Cholera increased as the weather in March 
and April became cooler and more damp. — With warmth and 
dryness of the air the disease rapidly abated. When, however, 
in August and September the days became very hot, and the 
nights cold, it again raged to an alarming extent. 

The prevalence of the disease at Moscow is stated to have 
been in proportion to the humidity of the atmosphere. 

At Vienna the Cholera broke out on the 13th of September, 
after a hurricane and much cold rain. 

At Dantzic so irregular and unfavourable to health had been 
the weather of the spring, that pestilential diseases were ex- 
pected as a consequence. 

The prevalent winds, in most places in which the Cholera 
committed its ravages, have been easterly, from N. E. to S. E. 
Such winds, be it remembered, have almost invariably prece- 
ded and accompanied some of the worst pestilences and various 
fevers— such as plagues, yellow fever, and violent bilious and 
intermittent fevers. 

Among the phenomena worthy of record connected with the 
history of Cholera, is the sickness and mortality of animals 
antecedent to and at the time of the ravages of the disease, in 
many parts of the world, where it prevailed. 



u 

III Localities of Cholera. 

IN INDIA. 

Jessore — where the Cholera first attracted general notice by its 
unusual virulence, is a crowded, ill-ventilated place, surrounded 
by a thick jungle, and exposed, during the rains, to the effluvia 
of an immense quantity of stagnant water. The district of 
which it is the capital, in its southern quarter is composed of 
the " Sunderbunds," a name given to the numerous, low, marshy 
islands, contained in the Delta of the Ganges, and formed by 
the different channels through which that river travels to the 
ocean. The Sunderbunds are overgrown with wood, and in- 
habited only by tigers, reptiles, and such other denizens of the 
wilderness. 

Calcutta.— In the official notification of the existence of ma- 
lignant Cholera, forwarded 16th September, 18 17, from the chief 
magistrate of the city to the government, it was stated that the 
disease was raging with extreme violence, particularly in the 
poor and unhealthy districts of the town and suburbs. Here, 
truly, the scene was deplorable. To convey an idea of the com- 
plicated wretchedness of the lower classes of Hindoos and 
Mussulmans at this period, it will be necessary to speak of 
their habits and places of abode. The " City of Palaces" forms 
only one (the English) half of the city of Calcutta; the other is 
the native town, which contains, in connexion with the suburbs, 
at least 500,000 inhabitants. The native town is chiefly com- 
posed of miserable lanes, narrow, dirty, and unpaved; and the 
majority of the dwellings are low huts, with side walls built 
of mud, mats, and bamboos, and covered with small tiles. 
Amongst the swarming population of these filthy receptacles, 
in which all descriptions of disgusting animal and vegetable 
odours abound, the distemper ran a long and wide career of 
destruction. Barely existing on a meagre diet of bad rice, the 
poor workmen, who had been abroad all day pursuing their 
laborious avocations in the sun, returned to their hovels in the 
most fitting state of body to contract the disease. Exhausted 
by the heat and fatigue, and confined during the night with 
their families, often six or eight in number, in a small space, 
to which fresh air was a stranger, they were attacked by Cho- 
lera in hundreds; and a frightful proportion of those attacked, 
were swept away in the lapse of a few hours. This was more 



15 

especially the case in the lowest part of the town and suburbs; 
and in the adjacent villages of Kidderpore, Manicktolla, Ent- 
ally, Chitpore, Sealdah, Sec. The condition, indeed, of the 
inhabitants of the latter places, is hardly to be imagined. — 
These villages are made up of mud or straw huts, which are 
individually from six to twelve feet square, and so huddled to- 
gether that there is scarcely room to pass between. In each of 
these unhealthy habitations a whole family resides, and not un- 
frequently, cows and other domestic animals are added to the 
proper inmates. These dependencies, moreover, are everywhere 
intersected by pools, broad ditches, and channels, which, in 
the rainy season become the reservoirs of foul water and cor- 
rupt weeds. 

Bombay. — Cold and moisture were strong predisposing 
causes. In the Kamati village which lies low, and is surround- 
ed, during the rains, with water, the inhabitants are chiefly 
Hamauls, who are much exposed, both day and night. Among 
these people the disease was most rapid in its progress, and, in 
proportion, was attended with the greatest mortality. Among 
the better classes many individuals were also attacked, but a 
very small proportion has died, when assistance was timely 
procured. 

Of the two native corps, one, newly raised men, deficient in 
clothing and comforts, suffered most. 

The disease first appeared in a lane. 

Madras. — Certain local circumstances and a peculiar state of 
the weather appeared to have a considerable inflence in occa- 
sioning the variations in the disease: — dry, clean, open situa- 
tions were obviously the most healthy; while moist filthy situa- 
tions, and such as were inhabited by the poorer classes, gene- 
rally presented a great number of sick, and those frequently of 
a bad description. This was well illustrated at Vipery, in a 
situation abounding with stagnant water, the receptacle of 
every species of filth, but more especially at the spot, where 
it was strongly suspected the epidemic first broke out at Ma- 
dras, and where many fell victims to its severity. For, it was 
observed to be more prevalent amongst, and, indeed, for the 
first two or three days, almost exclusively confined to, the na- 
tives residing in some huts, about which, much offensive and 
corrupted matter had been accumulated, while those occupying 
the houses almost contiguous, suffered but slightly, though 
comparatively more than the inhabitants in the adjacent and 



16 

more distant streets. Damp and exposure are said to have been 
influential causes. 

During the prevalence of the cholera in the 89th regiment in 
Fort St. George, in February, 1828, it was entirely confined to 
one end of the barracks; the three companies occupying the 
upper floor of the north end were the only sufferers: finding the 
disease to be daily increasing in these companies, they were re- 
moved to a bomb-proof, and it was observed after this not a 
single case occurred. The sickly end of the barracks was con- 
tiguous to the ditch of the fort, as also the men's privies and 
cooking houses, and to a drain, running immediately under the 
north-western angle, which at times is exceedingly offensive. 
Another modifying cause was the exposed situation of the bar- 
racks to the keen north-west (land) winds scouring along the 
glacis and directly into the rooms in question, about three 
o'clock in the morning, after a hot and sultry night, the men 
being often naked and exhausted by the previous heat. 

In the march of the 1st and 8th Light Cavalry to Seroor, dur- 
ing the months of February, March, April, and May, the sur- 
geon says he had occasion to observe the necessity of attention 
to choosing high ground, at a distance from water, for encamp- 
ment. " No case of Cholera appeared, he says, in camp, until our 
arrival within a few marches of Chittledung, when unfortunately 
having pitched on the banks of a mullah containing a large 
quantity of stagnant water, it was lamentable to observe, that in 
a few hours from the time of our arrival, no less than fourteen 
cases of sepoys were admitted into the hospital, suffering from 
the spasmodic Cholera in its gravest form. I took an opportu- 
nity of remarking to the officer commanding, the probability of 
the disaster having been occasioned by the encampment in the 
situation above described, and I have the satisfaction of observ- 
ing that much attention being subsequently paid to this in par- 
ticular, the disease in a few days suddenly left the camp, and 
not three cases occurred afterwards in a march of two months." 

In a large camp in Candeish, one corps at the left of the line 
was found to suffer extremely from the disease, whilst that which 
was at the opposite extremity entirely escaped. The former was 
in a lower and more confined situation than the other, the latter 
being situated between two hills where there was a strong cur- 
rent of air. The corps, which escaped, having marched, another 
corps arrived and took its place, and enjoyed the same immu- 
nity, the epidemic still existing in other parts of the camp. 



17 

And that the exemption was not owing to want of susceptibili- 
ty was proved, at least in one instance; for the first of these 
corps suffered very severely on its march after leaving the sta- 
tion. The 53d regiment was stationed in an airy and rather high 
situation at Trichinopoly when the disease appeared: they did 
not escape, but they were attacked the last. It first appeared at 
Masulipatam among convicts in a bomb-proof, (a chamber like 
a cave in the ramparts,) and was for some time confined to that 
chamber before it appeared in the rest. It was different from 
that of the other bomb-proofs, in being ill-ventilated, crowded, and 
extremely damp. Throughout it furnished more cases than the 
others. Some further time elapsed before the disease spread to 
the free population. Other prisoners in a dry and commodious 
jail, at the same time, suffered much less. 

Two parties of European recruits arriving at Madras, one is 
sent into bomb-proofs in the fort, and the other into barracks at 
the Mount, eight miles off. The former is attacked whilst the latter 
remains free, and on being also sent to the Mount, has no more 
cases. A corps encamped on low ground in very rainy weather, 
was severely visited ; of thirteen sepoys taken ill, six died. After 
a few days they moved to a higher spot, and only one more case 
occurs, which appears on the march to the new ground. During 
an attack of the epidemic, experienced in April, 1823, by the 
69th regiment in quarters, at the suggestion of the surgeon, the 
wing of the corps in which the disease prevailed the most, was 
encamped on a piece of high ground in the neighbourhood, and 
he reports that not a case occurred in that camp. The reap- 
pearance of the disease at Palamcotta is thus spoken of — " It 
commenced its ravages to the north-east of the fort, and spread 
pretty generally through the small, low, dirty, and close houses 
in every direction. The hospital escaped its influence, probably 
because it stood on high ground, and was very open all round, 
for certainly none of the sick, though upwards of ninety, were 
attacked. Only one person in the hospital was attacked, and he 
was in the habit of absenting himself from it at night." 

In reference to the disease as it prevailed in the centre divi- 
sion of the British army in India, in the year 1818, we learn, 
that in the three grounds of encampment, the soil was low and 
moist, the water foul, stagnant, and of brackish quality, and 
every where not more than two or three feet from the surface 
of the earth, and the vicinity abounded in animal and vegetable 
putrefied matter; whereas, at Erich, where the army regained 
its health, the situation was high and salubrious, and the water 



18 

clear and pure from a running stream. As illustrating the 
differences in locality, it may be well to add, the disease, though 
prevailing so fatally in the camp, did not reach Allahabad for 
four months afterwards, and yet the intercourse between this 
town and the camp was very great. Even some corps of the 
division, stationed at a little distance, escaped, though a dis- 
eased party arrived among them from the main body. 

From the uniform result of queries sent round to the police 
officers of the different departments, it appeared that the vil- 
lages in Sylhet, in which Cholera raged most extensively, were 
considered by the natives as comparatively unhealthy, and ob- 
noxious to intermittent fevers. 

Seringapatam is one of the most unhealthy spots in India: 
it lies in a basin formed on all sides by hills, and is surrounded 
to a considerable distance by rice fields, watered by canals 
drawn from the Cauvery river. The proportionate mortality 
from Cholera was greater here than at any other place in the 
peninsula. 

In Nitdea, high and dry places, and upper-roomed houses, 
were more free than low and marshy spots covered with luxu- 
riant vegetation. In the barracks of the European regiment at 
Berhampore, of twenty-four casualties, seventeen took place in 
two companies inhabiting the lower range. Similar results 
have been observed in reference to remittent fevers in more 
northern climates. Pringle tells us of the number of sick among 
the troops in Flanders, quartered on the ground floor, whereas 
those in the upper stories escaped. 

IN PERSIA. 

Tabriz.— The disease, says Mr. Cormick, first began in that 
part of the city which is most low, filthy, and crowded with 
poor inhabitants, and advanced from quarter to quarter of it, 
finishing its ravages in one before it commenced them in an- 
other. It was most destructive in the houses which were low 
and possessed most inhabitants. 

IN RUSSIA. 

Moscow. — The greatest number of deaths occurred in the 
marshy sections of Moscow, bordering on the Moskwa and Ka- 
nal. These rivers frequently overflow to such a degree that the 



19 

water reaches the lower windows of the houses in the neigh- 
bourhood. 

St. Petersburgh. — The situation of St. Petersburgh, on marshy 
and made ground, would prepare us for the appearance of the 
disease, in those parts especially where the houses were crowd- 
ed in narrow, ill-cleansed, and ill-ventilated streets. But there 
is a curious fact connected with locality in the history of the 
Cholera in that city, which deserves mention here. Kristofsky 
island, situated in the middle of the populous islands of St. 
Petersburgh, and which communicates with them by two mag- 
nificent bridges, and with the town by a thousand barges, which 
bring every day, and especially on Sundays, a great many peo-- 
pie, who go to take a walk in that charming place. Kristofsky 
island, we say, was completely preserved from the reach of 
Cholera: there has not been a single patient in the three vil- 
lages which it contains. It is not to be supposed that the inha- 
bitants of those villages were of a different nature from those of 
the town: all the abodes of this island are country houses, empty 
in winter, and full of people in summer, either noblemen, art- 
ists, or citizens of the town. During the prevalence of the 
Cholera in St. Petersburgh, almost all the French players re- 
tired to Kristofsky, and not a single patient was found amongst 
them; while out of the small number of their companions who 
remained in town, many either died from the disease, or were 
seized with its most violent form. The salubrity of this spot 
has been said to be owing to the many neighbouring woods 
by which it was protected from the choleric influence, what- 
ever that may be, or however mixed with the atmosphere. — 
" The island is a low and damp one, exposed every night to 
cold and heavy fogs, and fouled every Sunday by the excess 
of people who go there to gorge themselves with intoxicating 
liquors." It is, however, important to bear in mind, that 
owing to its being a summer retreat, the better class only of 
the population may be presumed chiefly to inhabit it — nor are 
they crowded or penned up together, as in many other parts of 
a populous city, in which persons spend both day and night, 
and in which the air is deteriorated, not only by secretions and 
exhalations from their bodies, but from various manufactories. 

In the lowest part of the basin surrounding the Caspian sea, 
and which is three hundred and forty feet below the level of the 
ocean, the Cholera spread itself after it appeared in Astracan, 
that is in the east and south-east parts of European Russia. 

Nishni Novogorod is on the right banks of the two rivers 



20 

Oha and Volga, which are here steep — two hundred feet in 
height. The land on the left banks of both rivers stretches out 
low, sandy, and is at times overflowed, presenting, in fine, ex- 
tensive flats. 

In what, a priori, would seem to be favourable healthy loca- 
lities, as Orenberg, the disease committed fewer ravages. Out 
of a population of 21,000 inhabitants, there were two hundred 
deaths.* The people, however, pay little attention to cleanliness 
and salubrity of dwelling. 

We ought not in considering the predisposing causes or mo- 
difying circumstances under which the disease has occurred in 
Russia, to forget that the inhabitants, especially of the lower 
classes, live in close rooms, raised by stoves to a tropical heat 
but without a tropical ventilation. The air is not renewed in 
the houses and ultimately becomes pestilential. 

IN POLAND. 

At Warsaw the habitations of the lower classes, who were 
the chief sufferers from the disease, are very dirty, and are but 
poorly ventilated or not at all; they are situated principally on 
the borders of the Vistula, and are in fact mere drains; hence 
it is in this part and in the low and narrow streets that sickness 
and death are most frequent. 

IN PRUSSIA. 

Berlin. — The greater number of sufferers from the disease 
lived in obscure streets, almost inaccessible to either the sun's 
rays or to the winds, and in low, damp, and often filthy dwel- 
lings; whereas, airy dwellings, in which cleanliness was attend- 
ed to, remained free from attacks. Entire quarters, such as 
Friedrichstad, on account of their spacious and well-aired houses 
and streets, well-ventilated by currents of air, were, with a few 
exceptions, preserved from the pestilence, and even these ex- 
ceptions occurred only in the back buildings. 

In Berlin the first cases of Cholera appeared among the skip- 
pers in the boats lying on the river Spree, which flows through 
the town, and in houses in the immediate vicinity of the river. 
In general the streets of Berlin are wide and airy, and the poorer 
classes of the population, in place of being pent up in interme- 

* Tripoli, in Syria, represented as clean and well ventilated, lost but five 
persons out of a population of 15,000. 



21 

diate alleys and confined courts, occupy the suburbs. Berlin 
suffered comparatively little from the disease. 

Vienna. — The locality of the disease was the same as in other 
places, but the class of people different. The nobility reside in 
the old and low part of the city, near the Danube, and on the 
first floors of the houses: they suffered greatly. 

Hamburg is situated on the Elbe, and part of the city is 
built on islands formed by the divisions of the river. At 
high tide the banks of the river are frequently overflowed. 
There are no less than eighteen hundred cellars inhabited by 
families — these are at times overflowed. There are also a great 
number of small damp courts and alleys inhabited by the poor, 
into which the sun seldom penetrates. The Cholera first ap- 
peared in what was called the deep cellar, among the lowest and 
most destitute class of paupers, at a time when the sanitary 
cordons and rigid quarantine restrictions were imposed to pre- 
vent its introduction from Prussia. 

In Breslau, the capital of Silesia, the disease was first seen in 
the faubourg of the Oder, a very damp place, intersected by 
marshes and stagnant water, and where intermittents of the 
worst kind prevailed. 

IN GREAT BRITAIN. 

The southern part of Sunderland, in which the disease began, 
and prevailed to the greatest extent, consists of streets which 
are mostly narrow passages, crowded with the thickly popu- 
lated houses of the poor, badly paved, with a gutter in the cen- 
tre, where all the filth of human habitations is heedlessly thrown, 
and still more carelessly left to accumulate for weeks together, 
upon the town moor. 

The needy, filthy, ragged, starving, crowded population of the 
worst parts of Newcastle, Gateshead, and Glasgow, the inhabi- 
tants of the lanes of Rotherhithe, St. Giles's, Chelsea, St. Mary- 
le-bonne, in London, these it is who hitherto mainly suffered in 
Great Britain. It has been said, on the same authority, that, as 
far as London is concerned, the banks of the Thames are the 
throne and seat of Cholera. 

In Paris, the first appearance of the malady was among the 
wretched poor of the Isle de Cite, a small island formed by a 
division of the Seine — the streets are on made ground, and the 
houses crowded and ill- ventilated. 

C 



22 



IV. The Classes of People, and the Mode of Living of those who 
have died in the greatest numbers. 

Of all the circumstances predisposing to an attack of Cho- 
lera, say the East India surgeons, fatigue consequent to travel- 
ling, or to hard work in the open air, was the most powerful. 
Accordingly, we find that troops upon the line of march, and 
people whose occupations exposed them to the weather — as 
boatmen, fishermen, husbandmen, gardeners, grass-cutters, 
washermen, palankeen-bearers — were extremely subject to the 
disease. 

In India, the Cholera attacked the various classes of the in- 
habitants to a greater or less extent, according as they were 
more or less exposed to fatigue, and irregular modes of life. 
The Europeans suffered less comparatively, than the natives; 
and of these, the higher less than the lower classes. Women 
suffered less than men, and children in a less degree than 
either — of 481 deaths in eleven days in Bombay, 254 were of 
males, 172 of females, and 55 of children. 

In Europe, and especially England, these proportions will 
not hold; the females in some places suffering as much as the 
males. 

In the north of India, the Mohammedans used a more nutri- 
cious diet, and went better clothed than the Hindoos; and in 
general, they were less liable to the malady. That this did not 
depend upon the stronger constitutions of the former, is seen 
in the effect which succeeded to a temporary exhaustion. 
When the Cholera prevailed at Delhi, it happened to be 
the period of the year in which the Mohammedans observe 
their annual fast of the Ramazan. During this time all ortho- 
dox Mussulmans abstain from food while the sun is above the 
horizon. Persons of this sect, therefore, suffered more exten- 
sively during the fast than the Hindoos, who lived after their 
ordinary manner. At Calcutta.many of the workmen suffered, 
not in the ratio of their constitutional strength, but according 
to their temporary exhaustion. The mechanics working in 
the open dock-yards receive high wages, and live in a superior 
manner with regard to diet and other domestic comforts; yet 
they were more frequently seized than the day labourers of 
the poorest order, employed under shelter in the cotton screws. 

In Madras it was observed jthat very few of the lower castes 
escaped, who were given to intoxication, and slept exposed to 
the night air. 



23 

It has been justly remarked of the causes of the disease at 
Bombay, that fatigue, poor diet, bad clothing, and exposure to 
cold and moisture, particularly predispose to an attack. In 
that city, Cholera was nearly restricted to the class of the po- 
pulation which is most exposed to the severest labour and 
privation, and who are often obliged, not being possessed of a 
cot, to sleep on a mud floor, with scarcely a cloth to spread 
under them. 

Europeans, says another writer, become predisposed to the 
disease through intemperance, and more certainly if they ex- 
pose themselves in a state of intoxication to the night air, or 
fall asleep in an open place. The fatigue and exposure to 
which the natives are subject, together with a deficiency of 
clothing, bad food, the eating of cold fruits — as melons, cucum- 
bers, raw vegetables, &c, evidently lay them open to sickness, 
and never fail in producing more or less of fever and bowel 
complaints at this season of the year (July, 1818). But now, 
says the narrator, these common affections are much fewer in 
number than is usual, and the Cholera has, in stead, been the 
prevailing distemper. 

Testimony, to the like effect, has been borne with wonderful 
unanimity, by all the writers on Cholera, not only in India, but 
in China, Persia, Russia, Poland, Germany, and England. The 
disease was most widely disseminated, and most deadly in its 
effects among the serfs of Russia, who live in the extremest 
filth, and in habits of beastly intemperance. The houses in 
which the disease occurred in Moscow, were inhabited by a 
class of persons extremely poor, habitually filthy, and addicted 
to intemperance, and who lived in low and damp houses, and 
in cellars. Many of the chambers only nine feet square, were 
occupied each by thirty individuals. 

Every where in Europe, say the best authorities, on the sub- 
ject, the poor, the ill-fed, and the ill-clothed, and the intem- 
perate, have been the greatest sufferers.* 

When persons of note have fallen victims to the pestilence, 
we might, as in the instances of Marshal Diebitsch, and the 
Grand Duke Constantine, find an explanation in much mental 
anxiety and habits of intemperance. It has been stated on 

* This was written before the accounts of the ravages of the Cholera in 
Paris had been received. The disease there seems to have taken a wider 
range, but still the large, very large majority of sufferers, were of the class 
already mentioned, viz. the poor, the needy, the ill-fed, and badly-lodged, 
and those given to excesses. 



24 

good authority, that in ninety cases in a hundred, in St. Peters- 
burg, the common victims to Cholera were the irregular, the 
dissipated, those with broken constitutions, and impaired 
health, the badly fed, the badly clothed, and those who indulge 
in intoxicating liquors. 

The coarse ascescent food, the sheep-skin clothing, of the 
peasant, seldom changed, and worn even at this season (June), 
the protracted religious fasts, the subsequent intemperance, 
both in eating and drinking, the intolerably close apartments 
of the Russians of all ranks, their consequent sensibility to 
sudden change of temperature, render them in our opinion, 
say English physicians, in St. Petersburgh at the time, parti- 
cularly liable to suffer from the disease. 

At Warsaw the individuals affected generally belonged to 
the lowest class. Their condition, as we learn from intelligent 
physicians on the spot, is wretched; their food, very coarse 
brown bread, potatoe whiskey, salted meat and herrings, cheese 
of the country, and a paste made of water, which is very dim- 
cult of digestion. 

Three drunkards, after one of their orgies, perished by the 
disease in four hours, and a drunken servant in a hotel in 
which two French physicians lodged at Warsaw, was found 
dead in his bed. 

The agency of intemperance in predisposing to, and exciting 
the disease, is shown by the fact, that after it had begun to de- 
cline in Riga, the indulgence in intoxicating drinks, and other 
irregularities during the Whitsuntide holidays, caused a tempo- 
rary augmentation of new cases. The breaking out of the disease 
at Gateshead, in the north of England, was directly consequent 
on Bacchanalian festivities of Christmas eve. Women of dis- 
solute habits have been common victims to the Cholera. Any 
sudden change in the habits of an individual or people, as in 
congregating for religious and other festivals, or in soldiers 
encamped, and in the field, are strong predisposing causes of 
the disease. In India, on the occasion of an assemblage of 
pilgrims to worship, Juggernaut, the mortality was excessive. 
The like disastrous consequences were observed in the crowd 
of pilgrims at Mecca. The disease first showed itself in Po- 
land, among the soldiers, in the short and memorable, but un- 
fortunate campaign of 1831. It prevailed more especially 
among those who were fatigued by long and forced marches, 
exposed to the inclemencies of the weather, and who observed 
no precautions in regard to their health. Those regiments 



25 

were first and mainly sufferers who were encamped on low, 
swampy ground, between mountains, and the soldiers of which 
were fed upon little else than pork. After the battle of In- 
ganie, on the 10th of April, which was long and bloody, the 
Polish soldiers, heated and fatigued by their uncommon exer- 
tions, drank greedily of the muddy water of the marsh, and be- 
fore the night of the 12th, many were destroyed by Cholera* 

Among the causes of Cholera, none are more promptly or 
fatally operative than a depressed, anxious state of mind. 
This fact has been recorded by the medical men both of India 
and Europe. That many died of fright was generally an ac- 
credited opinion at St. Petersburgh, during the prevalence of 
the disease in that city. The only attendant upon the sick in 
the infirmary of Sunderland, who had died of Cholera, was a 
nurse. She was a comparative stranger in the institution, 
was greatly alarmed, and in the opinion of the narrator of the 
case, really died of fear. 

Insufficient and unwholesome food has been already stated 
to be one of the causes tending to bring on an attack of Cho- 
lera. The subject is important enough to authorize our in- 
troducing a few additional particulars in this place. Some of 
the English physicians in India maintained, that the disease 
was clearly referrible to the use of damaged rice, by the na- 
tives. This grain is their chief article of food, and when the 
crops are deficient, or the grain damaged by wet seasons, we 
can rarely conceive how prone the inhabitants must be to va- 
rious diseases, among which those of the stomach and bowels 
would naturally be the chief. The Russian physicians have 
also adverted to the agency of bad and indigestible food, in 
the production of Cholera in that country. This is distinctly 
admitted in the precautionary instructions issued by the Rus- 
sian and Austrian governments, and by the medical boards 
in Berlin and Hamburg, respecting the articles to be shunned 
as food — they are unripe and watery fruits, beer, hydromel, 
sour soup, mushrooms, cucumbers, and melons, sallad, and 
spoiled fish, and greasy food generally. The sale of cucum- 
bers and water-melons, which were peculiarly abundant in 
the fall of 1829, was prohibited by the magistrates at Oren- 
berg. 



26 

II. Means of preventing the Extension and mitigating the 
Violence of Cholera. 

Some persons have deemed it possible absolutely to prevent 
the breaking out of the pestilential or fatal Cholera in a city or 
district. This opinion grows out of the belief that the disease 
is transmissible either by persons or goods, or both, and that 
in this way it may be communicated from the sick to the 
well, from a place in which it rages to another before exempt 
from it. 

The great body of facts which have transpired, in the history 
of the disease in different countries, during the last fifteen years, 
are totally at variance with this creed. — Let us repeat some of 
them here, beginning with those respecting the first appear- 
ance of the disease in different cities of the world. 

It is generally admitted by the physicians of British India, 
that Cholera broke out in several different parts of Bengal 
nearly simultaneously, or at least without their having any in- 
tercourse with each other. It is also admitted that these out- 
breakings of the disease, some of them as early as May, 1817, 
were anterior to its appearance in Jessore, in August of the 
same year. It is common, however, to speak of the Cholera as 
beginning in this last mentioned city, whereas, in fact, its ori- 
gin might just as well be traced to Calcutta, where its presence 
was manifested nearly at the same time as in Jessore. Without 
further examining the question of the propagation or extension 
of the disease in India, since no comparison can be instituted 
between the effects of free and suspended intercourse in that 
•country, except in one instance, we shall pass on to a notice of 
the first restrictive measures pursued in that quarter of the 
world. The exception just alluded to, was the circumstance 
already mentioned, of the disease appearing in as rapid an 
order of succession in places to the south of Madras, at a time 
when the navigation and intercourse between that city and all of 
the latter was entirely interrupted by the force of the monsoon, 
as it had done in places to the north of Madras, when the 
navigation was open, and the commercial intercourse uninter- 
rupted. 

The governor of the island of Bourbon, admonished, as he 
thought, by the ravages of the disease in the Mauritius, took 
every possible precaution to cut off all intercourse between the 
former and all suspected places or ports; and with this view 



21 

established a most rigid quarantine. Notwithstanding all 
these measures, the disease made its appearance in the island. 

We begin our notices of the attempts in Europe to keep off 
the disease by restrictive measures of insulation and non-inter- 
course with Jlstracan. This city, it will be remembered, was 
the theatre of the disease for a time, in 1823. It then subsided 
without its spreading to the adjoining provinces. The con- 
clusions of the medical men, as given below, refer to the dis- 
ease in 1830. 

The chief physicians of the hospitals of that city, in their 
letter to the medical council at Moscow, among other details 
give the following: 

The Cholera first appeared one hundred wersts from Astra- 
can, on board the vessel of war, Bakon, last from the isle of 
Sara, a place exempt, at the time, from Cholera: this vessel 
was retained in quarantine in Sedlitz, sixty miles from Astra- 
can, and not one of the sick reached this latter city. The 
Cholera manifested itself rapidly and simultaneously in many 
parts of the city, without the sick having had any communica- 
tion with the places abovementioned. — The first person affected 
with the disease at Astracan, had not arrived from a sus- 
pected place, but was a resident of the city. 

At Orenberg, quarantine restrictions were equally unsuc- 
cessful. 

We learn from the official letter, signed by the physician, 
police officer, and others, that, after the most minute inquiries, 
the man first attacked with Cholera in St. Petersburgh, had no 
immediate intercourse whatever, with persons who had come 
from any other place — nor could direct personal intercourse be 
traced between any two of the first five or six cases. These 
occurred, be it remembered, at a time when the city was sur- 
rounded by sanitary cordons, and a rigid system of quarantine 
carried into effect, directly under the eyes of the government, 
and with an immense array of military force. 

The most careful and minute inquiries, as we learn from 
both a German and an English physician, instituted at Mos- 
cow, prove incontestibly, that the disease was not imported 
into that capital; but that it appeared there spontaneously. It 
was ascertained that the first four patients had not themselves 
been in any infected place, nor held communication with any 
person or persons coming from such a place. 

The British Consul (and he is borne out in his statement by 
the Livonian government) tells us, that the disease appeared 



28 

simultaneously in three different places at Riga.— The first 
cases were two stone-masons, working in the Petersburgh su- 
burbs, a person in the citadel, and a lady resident in the town. 
None of these persons had the slightest communication with 
the crews of barques, or other strangers. 

Dantzic was said to have received the disease from Riga. — 
The truth is, that there had been two cases a German mile from 
Dantzic on the 27th May — two in the town in different parts, 
on the 20th, and others on the 29th, in three or four villages 
near Dantzic. Now, the first vessel which left from Riga after 
the disease had broken out in that city, did not arrive at Dant- 
zic until the morning of the 30th May; and she had a clean 
bill of health. The captain of this vessel died on the 3 1st May, 
as it was supposed, but not proved, of Cholera. Be this as it 
may, the disease had appeared in different parts of Dantzic 
three days before the arrival of the vessel from Riga. — With 
Poland the intercourse had ceased since the beginning of the 
winter. 

Breslau, the capital of Silesia, in what was considered the 
enjoyment of the most perfect system of quarantine, both on 
the frontiers of the province, and on the river Oder, was sud- 
denly alarmed by the disease appearing in one of its faubourgs. 
The first case was of a female who had never quitted the city, 
nor ever been engaged in the traffic of clothes. After the most 
minute investigation by the public authorities, not the slightest 
evidence was obtained of this person having had communica- 
tion with any stranger, or goods suspected of being infected. 
In a few days after her death, many persons were attacked 
with Cholera, in parts of the city remote from each other. 

In some of the cities in Germany and Hungary, besides a 
total suspension of intercourse between those in which the dis- 
ease was present, and neighbouring as well as distant places, 
each house in which a person happened to be attacked, was 
immediately surrounded by a guard, and all communication 
between it and other houses was prevented. New cases, never- 
theless, continued to occur daily, in different parts of these 
cities- — and the precautions thus taken, seemed rather to in- 
crease the number of the victims of the disease, than to curtail 
its spread. 

Berlin, despite the sanitary cordon, composed of the choice 
troops of the kingdom, under the eye of the Sovereign himself, 
became a theatre for the ravages of the Cholera. 

The inhabitants of Hamburg, looking with anxiety towards 



29 

Prussia and the country eastward, and enlisting all the means 
in their power by sanitary cordons and quarantine, to prevent 
the disease from approaching in that quarter, found it suddenly 
appear in the midst of them, rising, as it were, out of the earth 
from the deep cellar, whose inmates were, as already recorded, 
the first victims. 

Similar restrictive measures imposed by the Austrian go- 
vernment, were attended with the usual want of success — and 
Vienna became a seat of the disease in more rapid succession, 
after other cities of Hungary and Poland, than had been ob- 
served of many places where no artificial barriers had been 
interposed. 

A rigid system of quarantine and guard vessels were of no 
avail to prevent the disease appearing in Sunderland. 

On hearing of the Cholera committing such ravages at Mec- 
ca, the Pacha of Egypt established a rigid quarantine for all 
persons and goods coming from Arabia. The caravan from 
Mecca was accordingly placed in a lazaretto three leagues from 
Cairo. Thirty-four days had elapsed since it left the former 
city — on the route it lost ten of its number of Cholera. In pro- 
portion as they approached Cairo they suffered less. When at 
the lazaretto, they were surrounded by the troops of the Pacha 
in two cordons — the one nearest the caravan being also sepa- 
rated from that more remote and external. Sentries were 
placed between the two cordons, so as to prevent all commu- 
nication between them. Nevertheless, in spite of all these pre- 
cautions, three days after the arrival of the caravan in the laza- 
retto, three soldiers of the first cordon were attacked with 
Cholera, one of whom died in a few minutes. On the same 
day, 15th August, four persons coming from Cairo with goods, 
were seized with the disease, and persons in the city were at 
the same time also its victims. 

In Alexandria the Cholera broke out in the city, and among 
the troops who formed the second or inner line from Aboukir 
to Marabout. 

These several facts all concur to authorize the positive con- 
clusion, that non-intercourse between places actually ravaged 
by Cholera, and places still exempt from the disease, however 
rigidly enforced, can give no certainty, nor even any well-found- 
ed hope of protection for those latter. The promised benefit 
from such restrictive measures has not been obtained, while 
the inconveniences and sufferings caused by them have become 
too manifest. 

D 



30 

Is the Cholera transmissible by Persons and Goods? — The as- 
sumption upon which the restrictive measures just detailed, 
have been based, viz. that Cholera is generally, if not uniformly 
transmissible by persons and clothing, or merchandise, is con- 
troverted at every step of our inquiries into the history of the 
disease. The facts and arguments preponderate greatly on 
the other side, and would seem to be continually augmenting 
with the increase of our knowledge of the habits of Cholera. 
A few will suffice for our present purpose. 

The persons composing the family of the Persian prince, 
quitted the city of Tabriz after the violence of the disease had 
already began to abate. They, however, carried the Cholera 
along with them, and continued to be attacked, from four to six 
a day, for about ten days, but not a single person in the villages 
through which they passed or where they slept, took the dis- 
ease. During the prevalence of the Cholera in Moscow, about 
forty thousand persons quitted that city, of whom a large num- 
ber never performed quarantine, and yet no case is on record 
of Cholera being transferred from Moscow to other places; and 
it is equally certain, says the respectable Prussian physician 
from whom we derive the foregoing statement, that in no situa- 
tion appointed for quarantine, has any case of the disease oc- 
curred. 

In the year 1823, during the period in which the disease first 
prevailed in Astracan, large numbers of persons left the city 
daily; nevertheless, they did not convey the disease either to 
remote cities or to the nearest neighbouring villages. In 1830 
many villages remained free from Cholera, notwithstanding the 
constant communications with the city — one, five wersts from 
Astracan, on the shores of the Wolga, where whole families 
and workmen sought refuge, when the disease was at its height. 
It was the same with many others, where not only families, but 
the sick were transported. 

Whilst the disease was raging at Breslau, after quarantine, 
found useless, was done away with, the intercourse between the 
city and the neighbouring burghs and villages was uninterrupt- 
ed. For six or seven weeks three or four thousand peasants en- 
tered into the city every day and returned to their homes. 
Many of them had communications with the houses of the sick, 
and yet to many of the villages the disease did not extend. 
Thus not a single case occurred at Shertunez, where more than 
two hundred persons repaired every day to their country seats 
• — the large burgh of Marieneu, east of Breslau, and the vil- 



31 

lages of Fabitz arid Neudorf, which join the city, and contain 
each from one thousand to twelve hundred inhabitants, equally- 
escaped. 

During the prevalence of the disease at St. Petersburgh, con- 
stant and free communication was kept up between it and a 
village about fifteen wersts distant, that of the Germans, and not 
a single case of disease occurred at the latter place. 

Taking these facts in connexion with the instance of exemp- 
tion from the disease enjoyed by the villages in the island of 
Kristofsky, notwithstanding unlimited intercourse between them 
and the city of St. Petersburgh, we shall know what value to 
attach to the statements of insulation of places and persons 
having protected them from Cholera. The fact of escape from 
the disease, by no means implies a correctness in the assump- 
tion that quarantine was the protecting means, the more es- 
pecially when we call to mind the well known circumstance 
recorded by different writers on the East Indian Cholera, that 
in the very centre of extensive districts ravaged by Cholera, 
there are certain narrow strips or patches of country, into which 
there existed no natural obstacles to the extension of the dis- 
ease, but into which it never penetrated, although all around 
was one scene of desolation. 

This part of the subject cannot be placed in a clearer light 
than by simply observing that the instances of immunity from 
the disease where unlimited intercourse had been allowed, are 
in tenfold greater number than where restrictions had been im- 
posed and non-intercourse enforced. Non-intercourse by sani- 
tary cordons and quarantines, do not even give an additional 
chance of escape. Their tendency and effect are the other way. 

There has not been found any appreciable connexion between 
the full and frequent intercourse of physicians, nurses, attend- 
ants, and friends, with the sick of Cholera, and the number of 
the former who have been attacked with the disease. If Cho- 
lera were thus communicable, a large majority of the persons 
designated, ought to have had the disease — whereas, in fact, a 
large majority of them entirely escaped. Those who were at- 
tacked were not in greater proportion than would have suffered 
from any prevalent disease whatever. At Moscow, five hundred 
and eighty-seven patients affected with Cholera, and eight hun- 
dred and sixty labouring under other diseases, were admitted 
into the hospital of Ordinka. This hospital consists of a single 
building, three stories high, communicating by stairs placed 
within the wards. The same attendants had charge of all the 



32 

patients; the different articles of furniture were distributed with- 
out distinction to the patients, and all their clothes were wash- 
ed together by the same persons. Of the eight hundred and 
sixty patients above alluded to, not a single one became affect- 
ed with Cholera, and of one hundred and twenty-three hospital 
attendants, two only were affected, a man and a woman, both of 
whom were disposed to the disease from very irregular conduct, 
for which they had been censured. 

Instances of entire immunity after constant intercourse with 
the sick, might be greatly multiplied both in India and Europe. 

The women who washed the clothes of the patients in the 
hospital at Orenberg, were entirely exempt from the disease. A 
like immunity was enjoyed by the attendants who helped the 
patients in and out of the bath, rubbed their bodies, dressed 
blisters, &c. in different Russian and other hospitals. 

The physician general to the town hospital of Dantzic, says, 
that there were five waiters always near the patients; eight men 
were employed in rubbing and bathing; nine medical men vi- 
sited the patients, of whom one was always in the room in the 
day time, two watching every night; no one of these twenty- 
two persons fell ill. 

I have visited, says Dr. White, the Gateshead hospital, dur- 
ing the time I had the honour of being physician to that insti- 
tution, under all circumstances of physical depression. I have 
breathed the atmosphere of its apartments for hours together; 
yet I, the attendants, the nurses, all equally exposed, have equal- 
ly escaped. Not a single individual in the profession has sus- 
ained an attack since the disorder has prevailed. 

We are not to suppose that physicians and nurses should be 
entirely free from attacks of Cholera — we ought, on the con- 
trary, to be surprised at the proportion being so small, when 
we consider how the extreme fatigue and loss of rest which 
they undergo, must peculiarly predispose them to the disease. 
Very different, however, would be the result, if physicians, 
friends, and attendants, were obliged to render their services in 
the close, confined quarters of a city or town, and in the damp, 
filthy, and ill-ventilated houses, of those who are in the greater 
number victims to the disease. Hence it becomes the duty of 
government, and the proper corporate authorities, to make pro- 
vision for the reception of the poor and needy in suitable hos- 
pitals, and also for an evacuation of all cellars, and underground 
lodgings, and close, dirty hovels, by their customary tenants. 



33 



TRUE MEANS OF PREVENTION. 
We are now to consider the means best calculated to prevent 
an extension of the disease, when once it has appeared. This 
is as much as can be accomplished by human powers. But al- 
though we cannot alter or amend those conditions of the atmo- 
sphere, which give origin to, or are essentially connected with, 
the disease, nor change the localities in which it for the most 
part has its home, we can do a great deal towards depriving it 
of its horrors, by diminishing the exposure to those occasional 
and predisposing causes which are found to be so destructive. 
The sanitary regulations promulgated and enforced with this 
view, are ranged under three heads. 1st. Those which regard 
the placej 2. Those in reference to habitation; and 3. Those 
relating to persons. 

SANITARY REGULATIONS. 

1. Those which regard the place. — The streets should be daily 
cleansed of all offal, dirt, and any impurities whatever, and the 
gutters frequently washed with running water. In no yard or 
open lot should any collections of dirt or animal or vegetable 
matters be allowed to remain, nor any ditch or pool be left un- 
filled with earth. No removable obstruction to a freer ventila- 

ion of courts, and alleys, and narrow streets, should be tole- 
rated. 

2. Those which regard the habitation. — The cellars should be 
kept dry, and the sinks cleaned out, or occasionally water with 
a little chloride of lime, introduced into them. This substance 
should be sprinkled over the floors of those cellars more par- 
ticularly, through which there is not a free current of air. Dis- 
solved in water, with the addition of a little quicklime, it should 
be applied as a wash to the walls of cellars, closets, and rooms 
in which many persons work together. Free ventilation of the 
sitting and bed rooms should be enjoined and practised — the 
floors dry-scrubbed, and, as well as the bedding and bed clothes, 
aired at least once a day. Arrangements should be made for 
suitable ventilation and constant renewal of the air in all kinds 
of rooms or halls in which a number of persons congregate to- 
gether, as in schools, churches, manufactories, &c. The air 
should be introduced in such a way as not to blow in a current 
upon the persons in the room, or to suddenly chill them after 
being heated. 



34 

No person should, if it can be possibly avoided, sleep in cel- 
lars or underground apartments of any kind, since experience 
has universally proved the greater liability of persons thus 
lodged to be seized with Cholera. Those who sleep on the 
ground, or on mud floors little raised from the surface, are in 
much greater danger than others sleeping in the second or third 
story of the same house. It was even remarked by Dr. Living- 
* ston in China, that in some houses, persons who slept on beds 
sometimes escaped, while those who lay on the floor, on mats, 
and the like, in the same apartment, had the disease in its 
worst form. Most of the cases which came under Dr. Living- 
ston's care, were, at the time of attack, in small, ill-ventilated 
apartments, commonly on the ground-floor. 

A number of persons in the same room tends to deteriorate 
the air, and if they sleep in it, the chances of disease are greatly 
increased"— hence crowded bed-rooms are especially prejudicial. 

3. Those relating to persons. — Personal cleanliness should be 
rigidly promoted by regular ablution or bathing in water of 
such a temperature as the feelings and experience of the indi- 
vidual teach him to be most agreeable and salutary. Frictions 
of the skin with a coarse towel or brush are particularly commen- 
dable, and in persons who have been suddenly chilled, or whose 
feet are habitually cold, these parts may be well rubbed with 
warm salt and water, or fine salt, or mustard flour. The cloth- 
ing, and especially the covering of the feet, should be thick 
enough to protect the body against sudden changes of tempera- 
ture, or from sudden cooling after being overheated. Flannel or 
domestic muslin will be found to be the safest for inner gar- 
ments. 

Exposure to the night air, or dews, should be avoided, and 
by persons unavoidably summoned abroad, clothing thick- 
er than that usually worn in the day should be put on. After 
being suddenly chilled, or wet by rain, a warm bath will be 
advisable. 

They whose business calls them abroad early in the morning, 
should not leave the house without eating something — such as 
a piece of stale bread, and some cold meat seasoned with a 
little mustard or pepper, and washed down with ginger tea, or 
the like, which can easily be prepared the preceding evening. 
The meals should be light, and repeated at suitable intervals, 
so that the body may never be oppressed by quantity nor weak- 
ened by hunger. The food should be plain and easy of diges- 
tion, consisting of those meats, which general experience has 



35 

shown to be nutritious and healthful. More reserve than or- 
dinary will, however, be required in the use of smoked and 
salted meats, aud especially of fat pork, the eating which, in 
some places, has been spoken of as an exciting cause of Cho- 
lera. Lobsters, and the like, are avowedly pernicious. All 
crude and' indigestible vegetables, and unripe fruits ought to 
be carefully shunned. No material change of the beverages 
used in families, at morning and evening, will be required. To - 
milk, so largely taken as food and drink, in different parts of 
the country, exception need not to be taken. But this remark 
does not apply to sour milk (bonny-clabber) which ought 
during the prevalence of the Cholera to be entirely abstained 
from. 

The increased predisposition to a fatal attack of Cholera, 
which has every where been found to result from habits of 
intemperance, ought to be a sufficient caution on this head. 
Those unaccustomed to the use of strong drinks should not 
by any kind of persuasion or false reasoning, have recourse to 
them — and the habitually intemperate, those prone to excess, 
cannot too carefully or speedily begin a reform. Abstinence 
from ardent spirits at ail times desirable, is, in seasons of pesti- 
lential visitation still more necessary. A substitute will be 
found for alcoholic stimulation, in the use of ginger and cayenne, 
as condiments with food. In the case of the man who has 
desisted from dram-drinking, these articles may be taken at 
stated times; the first, in the form of tea, the second, in the 
form of pills. 

The poor and needy whose food is scanty, and of bad quality, 
such as watery vegetables, bad bread, Sec, should be supplied 
with a better nutriment, in the form of good animal broth, 
good bread, a day old, and a suitable allowance of milk. 

In Gallicia a better diet furnished to the lower classes, at the 
expense of the Austrian Government, appeared to have contri- 
buted, as much as any other measure, to prevent the spreading 
of the disease. In a sugar manufactory at St. Petersburgh, 
where all the workmen had increased allowance of food, of a 
wholesome kind, no individual was attacked. It may indeed 
be said, that pure air and good substantial living, and a tran- 
quil mind, will be found among the best preservatives against 
Cholera. 

Temperance and regularity of life, in all respects, which are 
so serviceable in protecting against most diseases, are required 



36 

to be observed in a peculiar degree to ward off an attack of 
Cholera.* 

The Committee, in conclusion, deem it their duty to dis- 
tinctly recommend that suitable measures be taken by the pro- 
per authorities, for the establishment of temporary hospitals 
in different parts of the city, for the reception of Cholera 
patients, who have not adequate lodging and accommodations 
at their own dwellings; and also, that provision be made for 
removing all those persons who live and sleep in cellars, or 
other close, damp, and ill-ventilated rooms in streets, alleys or 
courts, in which the disease once showing itself would, without 
some such precautionary measures, commit dreadful ravages. 
Immediate specification may be made of a great number of 
under-ground rooms, used for lodging and sleeping, in the row 
of buildings between Front and Water streets, and of cellars in 
various parts of the city, in which men both work and sleep. 
Not only are the tenants of such rooms more prone to the dis- 
ease, but they are also less advantageously circumstanced for 
recovering from its attacks; nor can they be properly attended 
by physicians, nurses and friends, without detriment, and even 
danger to these latter, who would then be respiring a damp, 
close and impure air, and be liable to have their bodies sudden- 
ly chilled, after passing from the outer warm air into such a 
medium. 

* The following is an illustration of what care and temperance can perform 
in the sickly climate of India, in the way of preserving Europeans from the 
attacks of Cholera: — 

" Two bodies of men, one amounting to 300, the other to 100 persons, 
were located in adjoining situations when the Cholera appeared. The 
smaller body immediately determined to live temperately, and by avoiding 
the night air, and the other predisposing circumstances, which were obvious, 
to endeavour to escape the distemper. The plan succeeded so well, that 
only one individual was seized, of the one hundred. The larger body adopted 
no precaution. They lived in their usual way, and one-tenth of their whole 
number perished." — (Kennedy, p. 90, 91.) 



37 



CHAPTER I. 

Of the Origin of Cholera. — Is common as an Endemic Disease. — Illustration of 
Endemics, in the instance of Remittent and Intermittent Fevers. — Of the Dif- 
ference between Endemic and Epidemical Diseases. — Further example of 
Epidemic Disease in Influenza. — Causes of Epidemic Diseases. — Deteriora- 
ted air, affecting other animals besides man, also fruits, and vegetation gene- 
rally. — Instances of stagnant air occurring as a cause of Pestilence. — Defec- 
tive and bad food a cause of Epidemic Disease. — Influence of Civilization. 
Examples of destructive Epidemic Diseases in Greece and Rome, during the 
middle ages, and in later times, in different parts of the world. — The Plague 
is of home or spontaneous origin in a place, as proved to be in Dantzic and 
Marseilles. — Prevailed in JYorthern Europe long before commercial inter- 
course with the Levant. — The Cholera equalled in its range and exceeded in 
its mortality by preceding Pestilences. —Even in its present or Epidemic form 
it is not a new disease. — Is mentioned by Bontius, Paisley, Sonnerat, Curtis, 
Girdlestone, and others, as prevailing at different times in Hindostan, and 
by Sydenham in England. — Is Endemic in the United States. 

Before we proceed to speak of the symptoms, post mortem 
appearances, and treatment of Cholera, it may not be deemed 
amiss if, after some observations on epidemic and epidemic 
diseases,we give a brief abstract of the facts, so far as they have 
transpired, of the causes, and of the means of guarding against 
an attack of this malady. 

First; as regards the Origin of Cholera. — The disease termed 
Cholera Morbus, of which that now under consideration is but 
an aggravated or epidemic variety, is known to every reader 
as of no unfrequent occurrence in the summer season, in 
nearly all climates. The more common causes are great fa- 
tigue and exposure to the sun during the day, and to the cool 
air and dews of the succeeding night — the use of indigestible 
food, especially of crude vegetables, unripe fruits, certain kinds 
of game, and of fish, such as lobsters and crabs, and drinking 
newly-fermented liquors. In inter-tropical regions and countries 
contiguous to them, Cholera Morbus is endemic, that is, a dis- 
ease recurring annually at stated seasons from the operation of 
agencies fixed in and peculiar to the country, such as the air, 
soil, exposure to particular winds, the food used, and water 
drunk by the inhabitants. Intermittent fever, for example, is 
endemic in low marshy situations, or in alluvial and volcanic 
soils-— as in the fens of Lincoln and Cambridge-shires in Eng- 

E 



38 

land, parts of Provence and Brittany in France, the valley of 
the Po, and the country around Rome in Italy, and the eastern 
portions of many of the southern states in this country. But al- 
though the causes of intermittent fever are present the greater 
part of the year in particular districts, the inhabitants are not ne- 
cessarily sufferers from the disease. By adopting suitable pre- 
cautions, such as avoidance of extremes of temperature — the 
hot sun by day and the cold air by night — the use of plain and 
nourishing food and warm clothing— abstinence from ardent 
spirits, people may live long in a fever and ague country, with- 
out contracting the disease. 

It sometimes happens that diseases, commonly confined to 
particular districts of country, will take a wider range, and ap- 
pear with aggravated symptoms. We have had an example of 
this in the occurrence of remittent and intermittent fevers with- 
in the last ten years, in regions before exempt from them, and 
even on hilly and mountainous situations, where the disease had 
never been known to prevail before. Such occurrences maybe, 
at times, the result of uncommon atmospherical vicissitudes and 
deviations from the usual order of the seasons. At other times, 
we are unable to detect any perceptible cause or combination 
of causes to account for the production of the diseases in 
question. When thus diffused over large portions of country, 
and attacking persons in great numbers and with unusual vio- 
lence, they are denominated epidemic, remittent, and intermit- 
tent fevers. 

Another familar illustration of the difference between the 
common or endemic influences and the epidemical ones, is 
found in catarrh. Particular situations, high, bleak, and expos- 
ed to easterly winds render the inhabitants liable during the 
winter and spring months toxoids or catarrhs. We are, in nor- 
thern latitudes, all accustomed to see, and most of us to feel, this 
disorder, and the variety of disorders having their beginning in 
this one; and we have no hesitation in assigning the causes. 
Epidemical catarrh or influenza, on the other hand, which will 
affect the population of a whole country or continent, does not 
acknowledge these evident states and changes of the weather as 
the sole or necessary causes. Something else is superadded, 
which we can only appreciate by its effects. 

It would be very unphilosophical to argue from the general 
spread of remittent and intermittent fevers, or of influenza, and 
the number of persons affected in rapid succession with analo- 
gous symptoms, that any of these diseases was, as the phrase is, 



39 

catching 1 , or that persons, before in health, would become af- 
fected by intercourse with the sick. We all immediately admit, 
in these cases, a community of cause, the precise nature of which 
we cannot, either by our senses or any known instruments, mea- 
sure, but which we feel assured depends on some general dete- 
rioration of the atmosphere. That there is a great change in 
the atmospherical constitution, we have evidences, derived from 
the grains and fruits of the earth being deficient, and of bad 
quality, and from animals, wild, and still more, domestic ones, 
sickening and dying during the seasons of epidemical visita- 
tion. Conjoined with the change in the air are unusual pheno- 
mena in the earth itself, as earthquakes, volcanic eruptions, the 
water of wells becoming impure, fishes dying in the rivers, Sec. 
Whatever may be the actual state of the air at the time, 
which gives rise to an epidemic disease, we have abundant evi- 
dence to show that this cause is rendered infinitely more effica- 
cious in adding to the intensity and complexity of the latter by 
the combination of local causes— -such as the nature of the 
soil, its elevation above the ocean, with the sensible states of the 
air and the prevalence of particular winds. Thus, for instance, 
during the prevalence of a winter epidemic, or of influenza, al- 
though the major part of the population of a country are affect- 
ed by the altered, but yet unknown state of the atmospheric 
air, and complain of coughs, sore throats, pain in the breast 
and limbs, still the greatest sufferers are those living in low, 
damp situations, exposed toxoid and moisture, or to a preva- 
lent easterly wind. So, also, in autumnal epidemics, they are 
in most danger, who are exposed to the alternations of heat in 
the day, and cold and moisture at night— who work in low 
grounds and sleep on the ground floor, or exposed to the night 
dew, or, if more favourably circumstanced, who are blown upon 
constantly by a prevailing south-easterly wind. So obvious are 
the depressing and deleterious effects of certain winds during 
seasons of the visitations of epidemical disease, that they have 
been, on occasions, supposed to be the bearer of the pesti- 
lential principle causing and sustaining it. Thucydides in- 
forms us that the plague was thought to have been transport- 
ed from Egypt to Athens, by the southerly wind which conti- 
nued to blow for a length of time preceding and contempora- 
neously with the prevalence of the disease in the latter city. 
Easterly winds, so notoriously exciters of intermittent fevers, 
aggravating them when present, and bringing on relapses, are 
often precursors of violent epidemics. The summers preced- 



40 

ing the attacks of yellow fever at Gibraltar, in 1804, and 1810 
and 1814, were chiefly remarkable for a long continuance of 
easterly winds. Testimony has been borne to the prevalence 
of the south-east wind in similar epidemics, in the West Indies, 
and in parts of the United States. 

A stationary atmosphere, as where there has been a long 
calm, with little or no agitation of the air by winds, is often a 
powerfully contributing cause of epidemic diseases. Still 
more deleterious is a stagnant air loaded with exhalations from 
living bodies, as when a number of persons are confined to- 
gether in narrow limits and no adequate ventilation admitted. 
Prisons, camps, ships, and even hospitals, have on this account 
been the seats of direful diseases, to which the epithet pesti- 
lential applies with peculiar force. Not only is this contami- 
nated air the cause of disease and death to those constantly 
inhaling it, as they necessarily do, who are tenants of the close, 
damp cells of a jail, or crowded to excess in the ward of a hos- 
pital; but is, on occasions, destructive to those who come with- 
in its range, even for a short time, as in the case of physicians 
and others on visits of relief and mercy to the abodes of crime, 
misery, and poverty.. 

Memorable examples of the horribly destructive effects of a 
stagnant air, are furnished in English history — the first occur- 
red in England, the second in British India. At the Black 
Assizes, held in Oxford, in 1577, in the early part of the month 
of July, so great was the crowd, that the air became complete- 
ly deteriorated, and there were no less than 1500 persons who 
died, some, as the jurors, almost immediately, others after the 
lapse of a few days. Two hundred of the above number died 
out of Oxford, between the 4th and 12th of July. "After 
which," says Stone, " died not one of that sickness, for one of 
of them infected not another, nor died thereof any one woman 
or child." The second example is yet more terrific, as the loss 
of lives was brought on by vindictive cruelty. Of a hundred and 
forty-six persons, comprising the English factory, at Calcutta, 
who were made prisoners of by Surajah Doullah, and confined 
during the night in a dungeon partially under ground, only eigh- 
teen feet square, and with but one opening for light and air, but 
twenty-three survived till morning. Too many similar illus- 
trations of an infected air, are found in the dreadful mortality 
among slaves confined in larger numbers, between decks, on 
board of Guinea traders, 



41 

The kind, and more especially the quality of food as re- 
gards its nutritive properties, modify greatly the predisposi- 
tion to an attack of epidemic disease. The want of food, as 
in times of great scarcity is first and most severely felt 
amongst the poorer classes of the population, and hence one 
cause of the early and greater proportionate mortality among 
them, than in those in better circumstances. It is also wor- 
thy of remark and remembrance, that pestilence following 
famine is not simply referrible to the scarcity and want 
of food, but to a deterioration of its nutritive properties by a 
morbid state of the air, and deviation from the usual order of 
the seasons, and also to an increased excitability or suscepti- 
bility to disease, induced in people generally, by this altered 
state of the air. 

Seasons of great national calamity, by which the people of a 
country are greatly agitated and depressed, render them more 
prone to attacks of disease. The neglect, to a certain extent, 
of agriculture, and interruptions to commerce, place them also, 
at this time, under the influence of the causes already adverted 
to, as depending on scarcity of food. 

In the history of Europe, we find the widest and most de- 
structive pestilences to have prevailed in the ages of the great- 
est barbarism, when war and pillage were the chief employ- 
ments of the inhabitants, and when agriculture had made little 
progress, and commerce was too insecure to admit of the trans- 
portation of grain and other alimentary substances, from a 
country having a superabundance to another suffering from 
scarcity or famine. 

It would not be compatible with our purposes, in this brief 
sketch of epidemic diseases, to detail their visitations in differ- 
ent countries, from an early period to the present time. Some 
few notices on the subject will not be without interest. Both 
Greece and Rome were, we know, grievously afflicted at intervals, 
with fatal epidemics, to which the epithet plague was always at- 
tached. Thucydides has given us an eloquent description of 
that which devastated Attica, and from which Athens more es- 
pecially suffered during the Peloponnesian war. The origin of 
this pestilence was supposed to be in Ethiopia, thence extend- 
ing to Egypt, Lybia, Persia, and Greece. As has been recently 
said by a modern writer,* we are not, however, to suppose that 

* Noah Webster — A Brief History of Epidemic and Pestilential Diseases, 
fyc. 2 vols, 



42 

this disease, any more than others of a nearly similar reputed 
origin, is propogated by contagion from one person to another. 
It appears first where the original, or secondary causes are the 
most powerful. " If the state of the atmosphere over the world, 
at any one time, is equally vitiated by some unknown cause, its ef- 
fects will first appear in places where that state of air is most poiv- 
erfully aided by local vitiations, as in cities or marshy grounds" 
The chief local cause in Athens was the crowding together 
into the city, the inhabitants of the country, in order to avoid 
the attack of the Lacedaemonians. 

The reign of the Emperor Justinian was rendered remarka- 
ble among other circumstances, by a pestilence, or rather suc- 
cession of pestilences " which almost destroyed the human 
race, and for which," says Procopius, a contemporary histo- 
rian, "no cause could be assigned but the will of God. It did 
not rage in one part of the world only, nor in one season of the 
year. It ravaged the whole world, seizing all descriptions of 
people, without regard to different constitutions, habits, or 
ages; and without regard to their places of residence, their 
modes of subsistence, or their different pursuits. Some were 
seized in winter, some in summer; others in other seasons of 
the year." 

But the most awfully destructive pestilence which the world 
ever experienced was in the period which intervened between 
the years 1345 and 1350. We are told in the histories of the 
times, that it commenced in China. It appeared in Egypt, 
Syria, Greece, and Turkey, in 1346; in Italy and Sicily, in 1347; 
in France, and the southern parts of Spain, and in England, in 
1348; in Ireland, Holland, and Scotland, in 1349; and in Ger- 
many, Hungary, and the north of Europe, in 1350. In this 
period a comet was visible — also meteors of various kinds; the 
seasons were irregular — myriads of insects were seen — domes- 
tic animals sickened and died — and fish were found dead in 
immense numbers. So deadly was the onset of this plague, 
that at least half, some say two-thirds, of the human race, were 
destroyed by it. It was most fatal in cities, but in no place 
died less than a third of the inhabitants. In many cities, nine 
out of ten of the people perished, and many places were wholly 
depopulated. In London, we are told that 50,000 dead bodies 
were buried in one grave-yard. In Norwich, about the same 
number perished. In Venice there died 100,000. In Lubec, 
90,000. In Florence the same number. In the East it has 
been said, with what degree of accuracy we cannot vouch, that 



43 

twenty millions perished in one year. In Spain, the disease 
raged three years, and carried off two-thirds of the people. 

In England, and probably in other countries, cattle were 
neglected, and ran at large ever the land. The grain perished 
in the fields for want of reapers; and after the malady ceased, 
multitudes of houses and buildings of all kinds were seen, 
mouldering to ruin. Although in the preceding year there had 
been abundance of provisions, yet the neglect of agriculture 
during the general distress produced a famine. Such was the 
loss of labourers, that the few survivors afterwards demanded 
exorbitant wages, and the parliament of England was obliged 
to interfere, and limit their wages, and even compel them to 
labour. See 23d Edward III., A. D. 1350. 

The disease reached the high northern latitudes; it broke 
out in Iceland, and was so fatal that the island is supposed 
never to have recovered its population. It was called the 
sorte diodj or black death. 

The pestilence was remarkably fatal to the monks and regu- 
lar clergy of all descriptions. At Avignon, where the disease 
first appeared in France, 66 of the Carmelites had died before 
the citizens were apprised of the fact; and when it was disco- 
vered, a report circulated that the brethren had killed one 
another. 

This is an important fact in the history of this epidemic, ad- 
verse to a belief in its contagion — viz. that the disease first ap- 
peared in a city not commercial, nor a sea port; and in a monas- 
tery which was probably crowded with idle and filthy monks. 

Our motives for introducing here the narrative of the awful 
plagues in the reign of Justinian, and in the first part of the 
fourteenth century, are to show our readers, that mankind have 
suffered more on former occasions from the visitations of dis- 
ease, than of late years from the dreaded scourge of Cholera; 
and also that they may be made aware of the ameliorating in- 
fluence of civilization — implying improved minds, and know- 
ledge, and a greater amount of means for promoting per- 
sonal comfort, and protection against morbid causes. Dreadful 
as the mortality from Cholera has been, we can promptly dis- 
cover that it is mainly restricted to a particular class, whose 
situation and, habits reduce them to a level with the large 
majority of the people of the middle or barbarous ages, and ex- 
pose them to the same calamities in seasons of epidemical dis- 
ease. When a pestilential malady, call it what you will, yellow 
fever, Cholera, &c, now appears in a city, but a small portion 



44 

of the inhabitants are victims to the disease. In former ages, 
analogous diseases passing under the common appellation of 
plague, would nearly depopulate a city. We have already 
mentioned the loss of 90,000 citizens of Florence, nearly a third 
of the entire population, by the plague in 1347. In 1359, on a 
similar visitation, the mortality was estimated at 100,000; 
whereas the deaths from the Cholera in Moscow, with a popu- 
lation of 350,000, in 1830, were short of 5000. St. Petersburgh 
also, with nearly an equal population, encountered the like loss. 
Vienna, containing 300,000 inhabitants, lost not 4,000. Even 
in Paris, where the mortality was excessive, amounting to up- 
wards of 15,000, yet when we consider the population of that 
city, upwards of 800,000 inhabitants, we cannot but be sensible 
of the increased advantages which the people of the civilized 
world at this time enjoy, of warding off pestilence entirely, or 
of greatly mitigating the violence of its attacks. 

In the next or latter part of the fifteenth century, viz. in 1483 
or 1485, a new species of plague appeared in England, called 
the Sudor Jlnglicus, or sweating sickness of the English, be- 
cause it was supposed either to have originated in England, 
or to have attacked none but Englishmen. This disease pre- 
vailed, however, at different times, in Ireland, Germany, Swe- 
den and Holland. It was remarked, also, as illustrative of a 
general deterioration of the atmosphere, at this time, that 
when the sweating sickness prevailed in Europe, this, or some 
other pestilential disease was raging in other countries. 

To the same argument, that the inhabitants of different 
countries are affected in epidemics by common causes, and 
do not infect each other, are numerous histories of these 
diseases. In 1654, the plague appeared in Chester, in the 
north-west of England, in Denmark, Russia, Hungary, and 
Turkey in the same season. The year of the great plague at 
Marseilles in 1720, was marked by increased mortality in the 
other chief cities of Europe, and also in various parts of Ame- 
rica. Many writers speak of the introduction of the plague 
into Marseilles from the Levant, by means of a ship from Said. 
But the account is not much better than pure fiction, since it is 
acknowledged that when the vessel left Said, the plague had 
not appeared in that port or town. Some of the crew did in- 
deed die on the passage, of malignant fever — but this disease, 
of whatever nature it may have been, was not brought from 
Said. It originated on board ship, and was not communicated 
to the inhabitants of Marseilles. Six weeks had elapsed from 



45 

the arrival of the vessel, and the death of the sailors, to the 
appearance of plague in the city. The disease was as de- 
cidedly of spontaneous origin here, as it had been twelve 
years before in Dantzic, from which the most rigorous mea- 
sures by quarantine and guards had been taken, to exclude 
its approach from Poland, and Hungary and Russia. 

Some places in the direct line of communication between 
others suffering at the time from the Plague, have escaped. 
The same remark has been made in reference to Cholera, and 
the explanation in both diseases is the same, viz.: that the con- 
currence of local causes was not sufficient to give effect to the 
general epidemical constitution of the atmosphere. When the 
Plague desolated Verona and Padua, in 1720, the city of Vicenza, 
which lies between the two, escaped. But next year this latter 
suffered greatly, when they were exempt from the calamity. 

National vanity always revolts at the acknowledgment of the 
home origin of pestilential diseases of any kind— an excuse for 
indolence, vice, and mismanagement, is found in making them 
of foreign origin. Plague has always been and continues to be 
a common disease in the Levant: it was once of frequent occur- 
rence in various parts of western Europe. Of later times, or 
within the last century, it has ceased to appear in these latter 
countries, and the inhabitants have become assured that it can- 
not any more break out among them, unless it be imported from 
Turkey, Egypt, or Asia Minor. Here we would ask, whence 
came those dreadful pestilences which ravaged Europe, when 
many places which suffered most had no intercourse with the 
reputed home of Plague. " The Plague was as frequent and se- 
vere in England, Denmark, Sweden, and Germany, in the tenth, 
eleventh, twelfth, and thirteenth centuries, before any foreign 
trade existed, as in any other period." Not to mention the uni- 
versal Plague in the days of Vortigern, about 448, which never 
has been exceeded in extent and violence, except by the black 
pestilence of 1348. 

" The Levant Company was first established by Queen Eliza- 
beth in 1581, and the act of incorporation expressly states, that 
i Sir Edward Osborn and his associates, the persons incorpo- 
rated, had at their own great cost and charges, found out and 
opened a trade to Turkey.' Before that time the commodities of 
Egypt, Syria, and Turkey, were all imported from Italy in Ve- 
nitian or Genoese ships."* 

* Webster, op. cit 
F 



46 

We have now, with as much brevity as possible, convinced 
our readers, we hope, that the present scourge of the world, the 
Cholera, is neither unparalleled in its course and extent by other 
epidemical diseases, nor has it been productive even of as great 
mortality as some of these. It now remains for us, in comple- 
tion of this part of our subject, to determine whether or no Cho- 
lera is a new disease. As an endemic it is a common malady; 
its epidemic character does not invest it with any specific dif- 
ferences; the difference is in degree, not in kind. But medical 
history satisfies us that, even as an epidemic productive of great 
and sudden mortality, it has shown itself at different periods 
during the last century in India. For this information we are 
mainly indebted to the Report of the Madras Medical Board on 
Cholera.* 

Bontius, a Dutch physician, who wrote in 1669 at Batavia, 
mentions the Cholera as prevailing endemically in that place, 
and frequently in so violent a form as to destroy nearly all 
whom it attacked within a single day. It is stated also, on the 
authority of Le Begue de Presla, to have prevailed in Bengal in 
1762; destroying thirty thousand negroes, and eight hundred 
Europeans. In Mr. Curtis's work on the diseases of India, 
there is a letter from Dr. Paisley, dated 1774, in which men- 
tion is made of the disease being then epidemic at Madras. It 
appears, also, from the records of the medical board to have 
raged as an endemic in 1769 or 70. In 1775 Cholera in- 
vaded the Mauritius, and in 1781 a division of the Bengal 
troops were attacked by it at Ganjam. Five thousand indi- 
viduals affected with the disease were admitted into the hos- 
pital during the first day, and by the end of the third, the 
half of the entire corps were ill. Men, previously in perfect 
health, instantly dropped dead, and few survived the first hour 
who did not ultimately recover. In the month of April, 1783, 
during a religious festival at Hurdwar, twenty thousand per- 
sons were destroyed by Cholera; and in the records of Madras 
it is stated to have raged at Arcot as an epidemic in 1787. 
Notices of its prevalence in particular districts in 1790 and in 
1814, are given by the East India surgeons. 

Sporadic cases of Cholera may occur at almost every season 
of the year, and in nearly every climate, from errors in diet, 
particularly from overloading the stomach with rich, acrid or 
undigestible food; from the sudden application of cold when 

* See Appendix. 



47 

the body is in a state of profuse perspiration, or from partaking 
under similar circumstances, of cold drinks; from the acciden- 
tal introduction into the system of various poisonous sub- 
stances — from intense anxiety of the mind and various other 
causes. 

The disease is chiefly prevalent, however, in warm climates; 
in those more temperate, being almost exclusively confined to 
the summer and autumnal months. In England, " it occurs," 
according to Sydenham, " as regularly towards the close of 
summer and in the beginning of autumn, as swallows in the 
commencement of spring, or cuckoos in midsummer." He 
describes an epidemic cholera which prevailed in England du- 
ring the summers of 1669 and 1676, in which the symptoms 
were so severe as to " frighten the by-standers, and destroy the 
patients in twenty-four hours." 

From its usual appearance in temperate climates during the 
heat of summer and season of fruit, it has very generally been 
ascribed, at least by the English writers, to the effects upon the 
system of an elevated temperature, and to the immoderate use 
of fruit — especially of such as is unripe, decayed, or highly as- 
cesent. There can be no doubt but that, to the combined agen- 
cy of these two causes very many cases of the disease are refer- 
rible. There are many other causes, however, by which an 
attack of Cholera is liable to be produced during the summer 
and autumnal months. Among these may be enumerated what- 
ever gives rise to the ordinary fever, and other complaints of 
the season, such as intemperance of every species — exposure 
to the dews of night, sudden changes in the heat and dryness 
of the atmosphere, excessive fatigue, &c. 

In nearly every city in the United States, but especially in 
New York and Philadelphia, independent of a large number 
of adults who fall victims to this disease — many hundreds of 
infants are destroyed by it every year. We are unable to pro- 
cure correct returns of the number of deaths from Cholera for 
a series of years for any other city than Philadelphia, in which 
we find that during the seven years ending January 1, 1832, 
1587 individuals are reported to have died of that disease. Of 
this number 67 were adults and 1520 children.* 

* See Appendix. 



48 



CHAPTER II. 



The fi)-st cause of Cholera is not knoion. — It is at any rate chiefly dangerous by 
the aid of the common causes of disease. — Atmospheric changes preceding the 
appearance of Cholera.— Influence of localities and modes of living on the 
production of the Disease. — Means of prevention stated. — Quarantine and 
similarly restrictive measures utterly useless, and ahvays injurious. — Cholera 
is not Contagious. — It is not transmissible by Persons or Goods. 

The cause by the operation of which the common and appre- 
ciable causes of disease give rise to Cholera is unknown to us. 
That it is in the atmosphere we have every reason to believe, 
but in what state or how combined, we cannot with any cer- 
tainty ascertain. It is, however, encouraging for us to know, 
as we now positively do, from all which has transpired in the 
history of the disease, that the concealed general or aerial cause 
is comparatively harmless, unless effect is given to it by our 
subjection to evident modifying agencies. 

Preceding and accompanying the appearance of the Cholera 
in a country or city, there have been deviations from the usual 
state of the weather and season — unwonted vicissitudes or ex- 
tremes, with changes in the electrical state of the atmosphere. 
These would not probably be of themselves adequate to the 
production of Cholera but for the additional predisposing cause 
of unfavourable localities. The chief home and seat of Cholera 
is in low damp situations — on the banks of rivers or near pools 
and ponds of water,— or which are encumbered with vegetable 
remains, and filth of any kind. — Those parts of cities thus situ- 
ated and circumstanced, have always suffered most, and some- 
times been the exclusive seats of the disease. In all the chief 
cities of Hindostan, as in Calcutta, Madras, Bombay, Seringapa- 
tam, Sec. Sec; of Russia, as in Moscow, St. Petersburgh, Astra- 
can; of Germany, as in Vienna, Breslau, Berlin, Hamburgh; of 
France, as in Paris and other places; of Great Britain and Ire- 
land, as in London, Sunderland, Newcastle, Gateshead, Mussel- 
burgh, Dublin, Cork, Sec; this fact has been placed beyond 
doubt. 

In Montreal, Quebec, and other places along the St. Law- 
rence, similar testimony has been afforded. Additional inten- 
sity is given to unfavourable locality by narrow streets, nume- 



49 

rous small and ill-ventilated houses, crowded with inhabitants, 
Low underground lodgings increase greatly the risk of their 
inmates having the disease, and the danger of its terminating 
in death. 

Experience has also fully shown that in regard to the manner 
of living, the intemperate, the devotedly sensual in any way, 
those unclean in their persons, and who are deprived of a suit- 
able supply of wholesome aliment, are peculiarly liable to the 
disease, and to perish under its attack. The drunkard has every 
where been singled out as the victim by the disease, on its first 
appearing in a place. The comparative exemption enjoyed by 
females, has been entirely lost to them by a dissolute mode of 
life. Women of this class have been among the foremost suf- 
ferers from Cholera. 

Food of a bad quality, irritating the stomach and bowels, has 
often proved an exciting cause of the Cholera. In India, the 
crops of rice fell short and were damaged, and the inhabitants 
whose chief reliance for nutriment was on this grain, suffered 
dreadfully from the disease. Similar deficiencies and badness of 
quality in the wheat in Russia and Poland, were attended with 
the like results. Wherever watery fruits and vegetables were 
largely used and relied on as food, such as cucumbers, melons, 
cabbages, &c. the disease committed great ravages. Meats, 
which, though nutritive, task excessively the digestive powers 
of the stomach, are to be avoided, such as fat pork, smoked 
beef, lobsters, and crabs. 

Among drinks, distilled liquors are especially pernicious. 
At all times improper for a habitual beverage, they are little 
short of poison when thus used in seasons of Epidemic Cho- 
lera. Water, under all circumstances, the best drink for man- 
kind, may be given of such temperatures, and so prepared by 
boiling, as to be adapted to every kind of stomach, and to prove 
both safer and more healthful than any other liquid whatever. 

Any sudden or considerable debility of the nervous system is 
to be greatly dreaded, as of itself laying the body open to an 
attack of Cholera. On this account, anxiety, fear, and the de- 
pressing passions in general, should not be allowed an abiding- 
place in our minds. Many have been destroyed by fear alone— 
but on the same ground as that on which a tranquil mind is re- 
commended to be preserved, an equable state of the senses and 
functions generally should be maintained, by regular hours of 
sleep — regularity of meals — and the accustomed daily exer- 
cise. 



50 

Long* exposure to the sun, and great fatigue, have been found 
to be powerfully contributing causes of Cholera. If circum- 
stances require imperiously such an exposure, additional cir- 
cumspection is to be exercised in the manner of living in other 
respects, and an especial avoidance of the night air and dews, 
or of getting wet with rain. 

The means of preventing an attack of Cholera readily sug- 
gest themselves to the reader, after he has been made acquaint- 
ed with the causes of the disease. The preventive and precau- 
tionary measures will consist in a careful avoidance of those 
situations in which the air is foul, stagnant, and loaded with 
moisture, and of every thing which has a tendency to reduce 
the energies of the system, either by over excitement or direct 
debility, and to impede the functions of the skin, or to induce 
disturbance of the digestive canal. 

The first and most important rule for the avoidance of Cho- 
lera is to preserve habits of strict temperance — no excess of 
any kind to be indulged in, nor experiments made of what 
the body will endure, either in the way of abstinence or re- 
pletion. 

The next rule is to observe the strictest cleanliness of per- 
son, clothes, and habitation. 

The third rule is to preserve the body by means of warm 
clothing, from the sudden impression of cold following heat, 
or cold with moisture — more care is demanded than under or- 
dinary circumstances, and garments of cotton or still better of 
woollen, next the skin, should be worn, even though they may 
be thought a little too oppressive. The feet should, above all, 
be preserved warm and dry. 

An avoidance of late hours, crowded assemblies, long conti- 
nued mental exertion and depression, will be so many circum- 
stances worthy of attention by those who would diminish the 
chances of an attack of Cholera. 

Another important rule is not to sleep in damp beds, or in 
low, damp, ill-ventilated apartments, and to shun exposure to 
the night air of swampy or marshy districts. 

In line, no medicine ought to be taken during the prevalence 
of Cholera in a place, without proper medical advice. — All 
pretended preventives and specifics for the disease, offered by 
advertising quacks, ought to be ranked among the most effec- 
tual means of inducing an attack of the disease. During the 
prevalence of the late epidemic at Montreal, the authorities 
very judiciously forbade apothecaries making up and vending 



51 

"without medical prescription, the medicines and nostrums 
eagerly sought after, with the hope of preventing or arresting 
the disease. Time is invaluable in Cholera, and much of the 
success in curing the disease, will depend on the early adminis- 
tration of suitable remedies. But urgent as may be the demand 
for assistance, it ought not to be rendered at mere hazard— 
with the risk often of increasing in place of diminishing the 
danger of the patient. 

We have said nothing as yet of the proper course to be pur- 
sued by our public authorities in order to prevent the introduc- 
tion of the disease into this country. Believing as we do, that 
all the facts connected with the rise and progress of the disease 
prove it to be an epidemic, depending upon some peculiar 
morbid change in the constitution of the atmosphere, we con- 
ceive that any attempt to exclude the disease from amongst us 
by quarantine regulations, which are always injurious to the 
commercial interests of a nation, or by a system of absolute non- 
intercourse with those countries where the disease prevails, 
would be as ridiculous as it would be unsuccessful. We have 
seen w r hat has been the result of these means, when carried 
into execution with all the strictness which it was in the power 
of the absolute monarchs of the North of Europe to enforce. 
In no instance have they succeeded in staying the progress of 
the pestilence, but have undoubtedly, in many instances, aug- 
mented the misery and sufferings of the people, and the 
number of victims to the disease. They have, in fact, been 
in the end entirely abandoned as worse than useless. But 
though the power of the Government cannot be exerted to 
guard our shores from the approach of the epidemic, it may be 
exerted in such a manner as to disarm the disease of much of 
its malignity, and prevent its extensive spread amongst us. 
This may be done by establishing at home, and without delay, 
an enlightened system of medical police; by taking effective 
measures to ensure the cleanliness and proper ventilation of 
our cities and their suburbs; by enforcing upon every class the 
importance of temperance, and especially of abstinence from 
every species of intoxicating drinks; by promoting by every 
possible means the comforts of the poor; by preventing their 
exposure to excessive fatigue, to cold and dampness, and to 
the noxious atmosphere of filthy, ill-ventilated, and crowded 
dwellings, and by endeavouring to supply them with food which 
is at once cheap, sufficient in quantity, and wholesome in qua- 
lity; and withal, by endeavouring continually, instead of ex- 



5 



* 



citing unnecessary alarm, to tranquillize and strengthen the 
public mind, and to inspire confidence in all classes of our ci- 
tizens. So far as these important points are carried into exe- 
cution, we may rest assured that much of the danger of the in- 
troduction of the Cholera into our country will be removed.* 

After the clear light in which the true epidemic character of 
Cholera has been exhibited in the Report of the College of 
Physicians of Philadelphia, it is hardly necessary for us, in 
this place, to strengthen, by many additional facts, the conclu- 
sions at which that body arrived, viz. that tha disease is not 
contagious. A very large majority of physicians and sur- 
geons of India are decidedly of the same opinion; their obser- 
vations led them to the following inferences: — 

1st. That medical men, hospital assistants, &c. were not 
more liable to take the disease than the rest of the community, 
— in many instances less so. 

2d. That it was not communicated by the clothing and beds 
of the sick to healthy subjects, or even to those labouring under 
the disease. 

3d. Regiments, marching from one station to another, get it 
all of a sudden, on reaching a certain spot, and the disease as 
suddenly disappears in a day or two, after "changing their 
ground. 

4th. It appears suddenly in a place, continues a week or two, 
and as suddenly disappears. 

5th. Particular parts of a station, or camp, are attacked in 
preference to others, when the communication is unrestricted. 

6th. Banks of rivers and water-courses are more obnoxious 
than high and dry situations. 

7th. On a change of the weather, the disease is sometimes 
arrested. 

8th. The disease passes by intermediate towns and villages, 
and seizes on more distant ones — a fact inexplicable on the 
principle of contagion. 

9th. Seclusion from, and non-intercourse with the infected, 
seldom or ever afford security against the disease. 

* The following extract from the official regulations, issued by the Austrian 
Government, will afford a useful hint to our authorities at home. " The au- 
thorities of different towns are enjoined to keep a rigorous watch over all 
taverns, inns, and houses of entertainment, as well as over all provision shops, 
to prevent, as far as possible, intemperance among the people, and the sale 
of unwholesome food ; and they are particularly required to ascertain the 
good quality of the bread delivered by the bakers." 



53 

10th. The crew of a ship from England took the disease im- 
mediately on her coming to anchor in Bombay harbour, before 
there was any communication with the shore. She had passed 
up along the Malabar coast, about seven or ten miles distant 
from the shore. This ought to set the question at rest forever, 
as showing the power of atmospheric influence in producing 
the disease. 

" In one of our visitations," says Dr. Meikle, long a medical 
officer in active service in India, " two or three companies on 
the right of the line were attacked, and there it continued for 
upwards of a month, without attacking a single individual in the 
lines of the other companies. They were daily exercised together, 
went to the same bazaar for their food, and drew water out of the 
same well" " At some ferries of particular rivers, few detach- 
ments have halted without suffering. The disease has, in these 
cases, broken out in the tent nearest the river, leaving all the rest 
untouched." 

In Europe, two series of facts, relating to the local origin 
and spread of the disease have transpired :— First, the best re- 
gulated restrictive measures, by sanitary cordons, and rigid 
quarantines, were of no avail in warding off the disease from 
Astracan, Moscow, St. Petersburgh, Dantzic, Berlin, Breslau, 
Vienna, Hamburgh, Paris, Sunderland, Newcastle, Cairo, and 
Alexandria. If these measures could ever be hoped to avail, it 
would have been when enforced, as in Russia, Austria, and 
Prussia, with the whole authority and power of the govern- 
ments of those countries. 

Secondly, it has been shown by official documents, that Cho- 
lera broke out and attacked persons, citizens respectively of As- 
tracan, Moscow, St. Petersburgh, Riga, Dantzic, Warsaw, Ber- 
lin, Breslau, Vienna, Hamburgh, Paris, Cairo, and Alexandria, 
who had had no intercourse with persons from abroad, nor with 
any who had been or then were affected with the Cholera. 
Moreover, the disease attacked, within the period of a few 
hours, persons in different and remote parts of these cities, who 
could not possibly have affected each other. The Cholera ap- 
peared first in England, in the town of Sunderland, notwith- 
standing guard ships and quarantine; and in its springing up 
suddenly in other towns in England and Scotland, could not be 
traced to a foreign source. For weeks, sometimes months, be- 
fore the breaking out of the Cholera in its epidemic and viru- 
lent variety, sporadic cases had occurred, and there was ob- 

G 



54. 

served a great tendency to gastric and intestinal disturbance, 
and often a troublesome diarrhoea. 

In the language of Dr. Kirk, of Greenock, we would say, 
" No man who carefully examines the habitudes of this disease 
without prejudice and prepossession, can come to any other 
conclusion but that, in all great irruptions of it, it is an epi- 
demic, depending on atmospherical and malaria influence. 
Dr. Lawrie's most graphic and excellent description of * the 
disease at Gateshead, and Gateshead Fell, need only to be read 
by any unprejudiced man to convince him that the unfortunates 
seized on the morning of the 26th Deqember, were smitten by 
an atmospherical epidemic, and not by contagion. 'The inha- 
bitants of Gateshead,' says Dr. L. 'fell asleep on the 25th De- 
cember, in perfect security, and devoid of panic, but before the 
sun rose on the 26th, fifty-five individuals had been seized, thir- 
ty-two of whom were destined not to see it set.' I have no 
doubt that a predisposition from the state of the atmosphere 
exists in every devoted locality of Cholera, for a length of time 
before it actually supervenes." 

Many who died of Cholera at Newcastle, says Mr. Lizars, of 
Edinburgh, were dissected, and some even 16 hours after death, 
without propagating contagion; indeed, with the exception of 
one, all the practitioners, upwards of fifty in number, are non- 
contagionists. Dr. Fyfe, of Gateshead, found in 67 cases, that 
44 of these were single individuals of families, varying from 
three to eight, many of them sleeping in the same bed with 
those sick with cholera. There was unlimited intercourse; 
nay, it was impossible to separate the diseased from the healthy. 

A similar view of the disease, as it recently prevailed at 
Montreal, is entertained by the physicians of that place. Dr. 
Kane, of Plattsburg, in his Report from that city, in reply to 
the question, Is the Cholera contagious? says — 

"1st. Many cases of Cholera appeared in the city six weeks 
previous to the 10th inst. (June) and therefore, long before 
shipping and emigrants arrived. The disease, however, sub- 
sided in thecourse of ten days or two weeks, after which, until 
the 10th inst. no cases appeared. 

" 2d. When the disease appeared on the 10th, it did so, to 
use the language of some of the physicians, ' like a shower of 
hail/ simultaneously all over the suburbs of the city, without 
any possible communications between the subjects of its at- 
tacks. It did not commence among the emigrants, and thence 
spread as from a centre to a circumference over the city. 



55 

" 3d. It cannot in any instance be traced to contagion. 
Nurses, and those who are among the sick much of the time, 
are not more frequently attacked with Cholera than those who 
are not exposed." 

The first official notice by the Board of Health, of the Cho- 
lera in New York, July 5, shows 2 1 cases, of which there were 
three in the Park Hospital, two in the Bellevue Hospital, one 
in the Alms House, and twelve in different streets in the lower 
part of the city. It is utterly impossible to prove, nor is it pre- 
tended to be believed, that these individuals were attacked in suc- 
cession, after intercourse with others sick with Cholera. The 
disease there, as in all the other cities, was evidently of home 
origin. 



56 



CHAPTER III. 

Symptoms of common Cholera — Alleged but not "proved difference between 
the essential characters of this and Epidemic Cholera. — Symptoms of the 
latter. — Great importance of attention to the premonitory symptoms of 
Epidemic or Spasmodic Cholera. — Among the chief of these, constituting a 
disorder in itself, is Diarrhoea. — Functions chiefly disturbed by Cholera. — 
Second, or febrile stage of the Disease, being the re-action following de- 
pression and collapse. 

The prominent symptoms of Cholera are repeated discharges 
from the stomach and bowels of a vitiated fluid, various in ap- 
pearance. In violent cases these discharges are accompanied 
with spasmodic pains in the bowels and limbs, paleness and 
contraction of the countenance, coldness of the extremities, and 
rapid exhaustion of the energies of the system. 

The term Cholera, by which the disease is designated, is a 
complete misnomer. So far from consisting in a morbid or 
excessive discharge of bile, as its name implies, in almost every 
case of Cholera the secretion of bile is at first deficient. In the 
milder forms of the disease, after a few hours continuance, bi- 
lious evacuations do, it is true, take places but this, so far from 
constituting an essential feature of the complaint, is, on the 
contrary, in general, an indication of its speedy and favour- 
able termination. In all violent attacks of Cholera, there is a 
total absence of bile in the evacuations, which are at first thin 
and watery, subsequently like the washings of fresh meat — 
sometimes, again, they are whitish, and of a mucilaginous 
appearance, like rice water or thin starch, at others, dark co- 
loured or variegated. 

The Cholera, as it presents itself under ordinary circum- 
stances, is marked by various degrees of violence. It is so 
slight an affection in some instances, as to terminate sponta- 
neously in a few hours; in others, it causes to the patient the 
most intense suffering for a considerable length of time, and 
when removed by an appropriate treatment leaves him in a 
state of extreme prostration, from which he slowly recovers; 
while in other cases which have fallen under our notice, we 
have known it to destroy the patient almost immediately; death 
being preceded by violent spasms of the muscles of the abdo- 
men and extremities; deadly paleness of the countenance; a 
shrinking of the features and icy coldness of the whole surface 
of the body. The symptoms, in fact, differing in nothing 



51 

from those observed in the Spasmodic Cholera which is now 
prevailing as an epidemic. 

The latter disease, it is true, has by several of the English 
physicians been supposed to be essentially different from that 
met with in England and other temperate climates, during 
summer and autumn, as well as from the ordinary endemic 
Cholera of warm climates. The arguments, however, by which 
this specific difference is attempted to be established, are alto- 
gether invalid. It has been said that in ordinary Cholera, the 
evacuations are of a bilious character, and frequently unaccom- 
panied with spasms, while in the epidemic disease the evacua- 
tions consist invariably of a watery fluid, in which no admixture 
of bile can be detected, and are accompanied with violent spasms 
of various muscles of the trunk and limbs. The former is as- 
serted to be a mild disease, readily removed by an appropriate 
treatment, and seldom fatal, whereas, the latter is always mark- 
ed by symptoms of extreme violence, is altogether unma- 
nageable, and rapidly destroys life in the greater number of 
those attacked by it. 

Most, if not all, of the destructive characteristics thus at- 
tempted to be drawn between the two forms of Cholera, have, 
in fact, no existence, or at least they are founded upon a very 
superficial acquaintance with the phenomena of the disease as 
it occurs in various situations and climates. The physicians 
of Montreal entertain a correct view of the subject, when they 
regard the Cholera, which recently prevailed in that city, as 
differing in no respect from the endemic cholera of the United 
States and the Canadas, save that it is now an epidemic. In 
both, the same organs are affected, and in the same manner, 
and the same phenomena are present. 

We have already pointed out the error of supposing that the 
discharges in ordinary cases of Cholera are from the first invaria- 
bly bilious: it is only in mild cases that a copious secretion and 
consequent discharge of bile speedily occur and put an end to 
the disease. In all instances in which the symptoms are in any 
degree violent, there is an entire absence of bile in the matters 
evacuated. To this fact nearly every writer has borne testimo- 
ny, who has described the disease from personal observation. 
Celsus describes the evacuations in Cholera as " at first like 
water, afterwards as though fresh flesh had been washed in it 
— sometimes white,*'* &c. 

* Celsus, it is true, applies the term bilis to the evacuations in this disease ; 
but there is reason to believe that the Latins made use of that term to desig- 



58 

Sydenham does not allude, in his description of the severe form 
of Cholera which he witnessed, to the existence of bile in the 
evacuations, but merely denominates them " vitiated humours." 
Bateman remarks that, in Cholera the evacuations are at first 
" thin and watery," but in the course of a few hours " pure bile" 
is discharged : and Johnson, when treating of the Cholera of 
tropical climates, declares that in all cases of the disease there 
is a diminution, in many u a total suppression of the biliary se- 
cretion." We can confidently affirm, from our own experience, 
that in the majority of the violent cases which we have witness- 
ed, the discharges were of the same watery appearance, until 
the disease took a favourable turn.f 

The greater intensity of the symptoms in the present Epide- 
mic Cholera — its rapid progress — wide spread, and the appal- 
ling mortality by which it has been so generally attended, afford 
no just grounds for describing it as a specific disease. They 
merely indicate a more violent grade of the malady, depending 
upon causes having a wider extension than those by which Cho- 
lera is usually induced. Cholera has frequently occurred epi- 
demically before the present period. Even in sporadic cases 
it presents every degree of violence; from the most trifling to 
that in which death is induced in a very short period. 

Premonitory Symptoms of Cholera. — On an early attention to 
the symptoms of this first or forming stage of the disease, will 
greatly depend the favourable issue of the case, and of course the 
life of the patient. The patient complains of lassitude. He has 
frequently partial uneasiness in the region of the stomach; but 
this not to such a degree as to alarm him. He has frequent eva- 
cuations from the bowels — from two to a dozen times a clay — 
not attended with much griping. His countenance is sharp and 
dark. He knows not of this symptom, and it is only recogniza- 
ble to the eye of experience. Occasional nausea may oppress 
him. But this is not a very common symptom. These symp- 
toms may continue, varying in severity, from one to ten days, 
before the second stage of the disorder supervenes. The eva- 

nate fluid evacuations generally, and not the bile alone, which was invariably 
denoted by the term/eZ. 

t In the histories of the Cholera during its prevalence in India, we find 
frequent mention of green or greenish discharges, (vide Bombay Report 
and Mr. Scott's Madras Report,) and Mr. Curtis, as well as Mr. Orton and 
■others, say expressly, that, in mild cases, the discharges in the Epidemic Cho- 
lera of the East were bilious. (See Curtis on the Diseases of India, p. 66, 
and Orton's Essay on the Epidemic Cholera, p. 71.) 



59 

cuations at the first are generally of a dark brown or blackish 
hue. As the looseness continues, they gradually become less 
and less of a natural appearance, until they assume the consis- 
tence and aspect of dirty water, Some headache, cramp of the 
fingers, toes, and abdomen, and almost always slight giddiness 
and ringing of the ears, accompany these symptoms. Some- 
times an intervening two or three days of costiveness super- 
venes, which is followed again by the diarrhoea, and in a few 
hours collapse supervenes, and in general nausea and vomiting. 
On the prompt appreciation of the nature of this diarrhoea, and 
timely application to a physician, will greatly depend the issue 
of the cure. Dr. Kirk says that it was found, from regular re- 
cords of upwards of 4000 patients, to prevail in all.* 

Symptoms of marked Cholera.*— From among the numerous 
minute and graphic accounts which have been published of 
the phenomena by which the epidemic Cholera is accompa- 
nied, from its invasion until its termination, it is somewhat dif- 
ficult to make a selection, but as our desire is, rather to present 
a general summary of the symptoms, than a detailed account 
of every trifling deviation from the ordinary course of the dis- 
ease, we shall follow very closely the very excellent description 
presented to us by Mr. Scott in the Madras Report. 

The attack of Cholera generally takes place in the night, or 
towards morning. The patient becomes sick at stomach, vo- 
mits, and his bowels are at the same time evacuated. This 
evacuation is of a nature peculiar to the disease*— >the entire 
intestinal tube, seems to be at once emptied of its foecal or solid 
contents, and an indescribable but. most subduing feeling of 
exhaustion, sinking, and emptiness is produced. Faintness 
supervenes, the skin becomes cold, and there is frequently gid- 
diness, and ringing in the ears; the powers of locomotion are 
generally soon arrested; spasmodic contractions or twitchings- 
of the muscles of the fingers and toes are felt; and these affec- 
tions gradually extend along the limbs, to the trunk of the bodyj 
they partake both of the clonic and tonic spasm, but the clonic 
form chiefly prevails. In other words, they consist more gene- 
rally of permanent contraction than of convulsive movements 
of the muscular fibres. The pulse, from the first, is small> 
weak, and accelerated, and, after a certain interval, but es- 
pecially on the accession of spasms, or of severe vomiting, it 

* See Appendix, in which precautions, based upon these premonitory 
symptoms, are given by Drs. Jackson, Meigs, and Harlan, of Philadelphia, 
after their visit to Montreal. 



60 

sinks suddenly, so as to be speedily lost in all the external 
parts. The skin, which, from the commencement of the dis- 
ease, is below the natural temperature, becomes colder and 
colder; it is very rarely dry; generally covered with a profuse 
cold sweat, or with a clammy moisture. In Europeans the 
skin often assumes a livid hue; the whole surface appears col- 
lapsed, the lips become blue, the nails present a similar tint, 
and the skin of the feet and hands becomes much corrugated, 
and exhibits a sodden appearance; in this state the skin is in- 
sensible, even to the action of chemical agents; yet the patient 
generally complains of oppressive heat on the surface, and 
wishes to throw off the bed clothes; the eyes sink in their orbits 
and are surrounded with a livid circle; the corneae become flac- 
cid, the conjunctiva frequently suffused with blood; the fea- 
tures of the face collapse, and the whole countenance assumes 
a cadaverous aspect, strikingly characteristic of the disease. 
There is almost always urgent thirst, and desire for cold drink, 
although the mouth be not usually parched. The tongue is 
moist, whitish and cold; a distressing sense of pain, and of 
burning heat at the epigastrium are common; little or no urine, 
bile, or saliva is secreted; the voice becomes feeble, hollow, 
and unnatural; the respiration is oppressed, and generally 
slow, and the breath of the patient deficient in heat. 

During the progress of these symptoms the stomach and 
bowels are very variously affected. After the first discharges 
by vomiting and purging, however severe these symptoms may 
be, the matter evacuated is always watery; and in a great pro- 
portion of cases it is colourless, inodorous, and often homoge- 
neous. In some it is turbid, resembling muddy water; in others, 
it is of a yellowish or greenish hue. A very common appearance 
is that which has been emphatically called the " congee stools" 
or like rice water, an appearance produced by numerous mucous 
flakes, floating in the colourless watery, or serous part of the 
evacuation. The discharges from the stomach, and those from 
the bowels do not appear to differ, excepting in the former 
being mixed with portions of the food which may have been 
eaten. Neither the vomiting nor the purging are symptoms 
of long continuance; they are either obviated by art, or the 
body becomes unable to perform the violent actions; and they, 
together with the spasms, disappear a considerable time before 
death. If blood be drawn, it is always dark, or almost black, 
ropy, and generally flows slowly and with difficulty. Towards the 
close of the attack, jactation, or restlessness, comes on, with 
evident internal anxiety and distress; and death takes place, 



61 

often in ten or twelve, generally within eighteen or twenty 
hours from the commencement of the attack. 

During all this mortal struggle and commotion in the body, 
the mind remains clear, and its functions undisturbed, almost to 
the last moment of existence. The patient, though sunk and 
overwhelmed, listless, averse to speak; and impatient of dis- 
turbance, still retains the power of thinking, and of express- 
ing his thoughts, as long as his organs are obedient to his will; 
such is the most ordinary course of the Epidemic Cholera, 
where its tendency to death is not checked by art. 

Cholera, however, like other diseases, has presented consi- 
derable variety in its symptoms; thus, it may on one occasion, 
be distinguished throughout by the absence of vomiting, and 
by the prevalence of purging; on another, by the excess of vo- 
miting; and, though more rarely, by the absence of purging. 
Spasm may be generally present in one instance: in another, 
it may not be distinguishable. A frequent variety, the worst 
of all, is, that which is marked by a very slight commotion in 
the system — in which there is no vomiting, hardly any purging, 
perhaps one or two loose stools; no perceptible spasm, no 
pain of any kind: a mortal coldness, with arrest of circulation, 
comes on from the beginning, and the patient dies without a 
struggle. 

Vomiting is sometimes, as already remarked, entirely ab- 
sent, or if it has been present, soon ceases from an atonic state 
of the stomach, under which that organ receives and retains 
whatever may be poured into it, as if it were really a dead sub- 
stance. Purging is a more constant symptom than vomiting, 
and in a large majority of cases, it is the first in the order of 
occurrence; but being a less striking deviation from a state of 
health, than vomiting, which instantly arrests the attention, it 
has usually been spoken of as occurring subsequently to the lat- 
ter. Purging has been very rarely absent altogether — its absence 
appears, indeed, to denote a peculiar degree of malignancy in 
the attack. There is seldom much griping or tenesmus, al- 
though the calls to the stool are very sudden and irresistible. 
They also sometimes take place simultaneously with vomiting, 
spasm, and a suspension of the pulsation at the wrist; as if all 
these symptoms originated at the instant, from one common 
cause. In advanced stages of the disease purging generally 
ceases, but in many cases a discharge of watery fluid takes 
place on every change of posture. The matters evacuated after 
the first emptying of the bowels, have been occasionally ob- 

H 



62 

served to be greenish or yellowish, turbid, of a frothy appear- 
ance, like yeast, and sometimes bloody; but by far the most 
common appearance is, that of pure serum, so thin and colour- 
less as not to leave a stain on the patient's linen. The next in 
order of frequency, is the congee-like fluid; the mucus is at 
times so thoroughly mixed, however, with the serum, as to give 
the whole the appearance of milk. The quantity of the clear 
watery fluid, which is sometimes discharged, is very great? 
and were it uniformly so, it might afford us an easy solution of 
the debility, thirst, thickness of blood, and other symptoms; 
but it is unquestionable, that the most fatal and rapid cases, 
are by no means those which are distinguished by excessive 
discharges. Death, on the contrary, has ensued in innumerable 
instances after one or two watery stools, without the develop- 
ment of any other symptom affecting the natural functions. 
Collapse has even come on before any evacuation by stool had 
taken place. 

The undisturbed state of the mind in this disease, has been 
the subject of general remark: instances are not wanting of 
patients being able to walk, and to perform many of their usual 
avocations, even after the circulation has been so much arrested, 
that the pulse has not been discerned at the wrist: the cases 
here alluded to, are those chiefly, in which it has begun by an 
insidious watery purging: and many lives have been lost in 
consequence of the patients, under these fallacious appear- 
ances, not having taken early alarm, and applied for medical 
aid. In other cases again, the animal functions appear to have 
been early impaired, and the prostration of strength to have 
preceded most of the symptoms. The voice, in general, par- 
takes of the debility prevailing in the other functions; it is usu- 
ally noticed as being feeble, often almost inaudible. Deafness 
has also been remarked, in some instances, to have been com- 
pletely established. Coma does occasionally occur, especially 
towards the termination of the case, when it is fatal: but deli- 
rium has seldom, or never been observed, unless as a sequela of 
Cholera. 

Spasm has been held to be so essential a feature of the Epi- 
demic Cholera, as to confer on it a specific name: in so far, 
however, as relates to the muscles of voluntary motion, and it 
is 'that description of spasm only to which we now refer, no 
symptom is more frequently wanting. Spasms of the muscles 
chiefly accompany those cases in which there is a sensible and 
violent commotion of the system — hence they are more fre- 



63 

quently found in cases where Europeans are the subjects of the 
disease, than when it attacks the natives of India, and in robust 
patients, more frequently than in the weakly. In the low and 
most dangerous form of Cholera, whether in the European or 
Indian, spasm is generally wanting, or is present in a very 
slight degree. The muscles most commonly affected, are those 
of the toes and feet, and of the calves of the legs: next to these, 
the corresponding muscles of the superior extremities, then 
those of the thighs and arms— and lastly, those of the trunk; 
producing various distressing sensations to the patient. Dr. 
Craigie, in his account of the disease as it prevailed in New- 
burn, (Eng.) says — " The cramps were observed chiefly in the 
gastrocnemius and soleus of the leg, in the biceps flexor of the 
thigh, and in the recti of the abdomen. In one or two instances 
I thought I felt the adductors of the thigh affected; and I think, 
had I examined a greater number of cases, I should have found 
this more frequently. But it is remarkable that none of the 
extensors of the thigh were ever seen cramped; and if those of 
the foot were affected, they also escaped notice. In the arms I 
never found the muscles affected with distinct cramps, but only 
thrown into spasmodic twitches. It is deserving of remark on 
this point, that in several instances the first indications of cho- 
leric attacks were twitching of the fingers and toes; and some 
persons who resisted all the other phenomena of the disease 
were assailed by this. A man who acted as gardener and man- 
servant to the Reverend Mr. Edmonston, and whose name has 
not been put down in my notes, complained, on Sunday the 
15th, of twitches of the fingers and hands, for which some gen- 
tle laxative remedy was in the mean time ordered. The fol- 
lowing day, about two o'clock, these twitchings had rather in- 
creased, but not to such an extent as to require very active 
measures. At four o'clock, as we were quitting the village, he 
ran up to Mr. Fife's carriage to say, that he had been, since 
two, attacked with several loose stools, and to request assist- 
ance, which was immediately ordered for him." 

Of all the symptoms of Cholera, none is so invariably pre- 
sent, nor indeed so truly essential and destructive, as the im- 
mediate sinking of the circulation. It must, nevertheless, be ad- 
mitted, that, where instant remedial measures have been suc- 
cessfully practised, this symptom may not have developed itself, 
and that there are even cases where an excited vascular action 
has been observed to accompany the first perturbation of the sys- 



64. 

tern in Cholera. Some intelligent practitioners have enter- 
tained doubts whether such cases belong indeed to this disease: 
it is, however, to be remembered, that these are precisely the 
cases which yield most certainly and readily to appropriate re- 
medies, and it consequently follows, that the physician can sel- 
dom have an opportunity of observing whether or not this form 
of Cholera will pass into a more aggravated stage. Cases 
however, have occurred, in which such degeneration has taken 
place, and it has then been followed by death. The symptoms 
of excitement have likewise principally occurred among sol- 
diers, in whom an effect upon the circulation may have been 
produced by the quantity of ardent spirits they are in the habit 
of drinking daily. 

The period at which a marked diminution of vascular action 
takes place, is somewhat various — the pulse sometimes keeps 
up tolerably for several hours, though very rarely: it more ge- 
nerally becomes small and accelerated at an early stage, and on 
the accession of spasm or vomiting, suddenly ceases to be dis- 
tinguishable in the extremities. The length of time during 
which a patient will sometimes live in a pulseless state, is ex- 
traordinary. 

Thirst and sense of heat, or burning in the region of the 
stomach, are generally connected together, and form very pro- 
minent and constant symptoms of Cholera^ yet not only in indi- 
vidual cases, but even in epidemic visitations, these symptoms 
have often been altogether wanting. Even when they are present, 
in the highest degree, the mouth is not parched, nor the tongue 
often dry$ on the contrary, there seems in general no want of 
moisture in these parts. The sense of thirst seems to subdue 
all other feelings — cold water is constantly craved and eagerly 
swallowed. 

The state of the skin is cold, generally clammy, and often co- 
vered with profuse cold sweats: nevertheless, varieties occur 
in this, as in other symptoms of Cholera— the skin is some- 
times observed to be dry, though coldj and sometimes of a na- 
tural, and even in some rare cases, of preternatural warmth. 
An increase of temperature has been repeatedly observed to 
take place just before deathj but the development of heat ap- 
pears to be confined then to the trunk and headj and, in almost 
all cases, this partial development of heat is found to be a fatal 
symptom: it is entirely unconnected with any restoration of the 
energy of the blood-vessels, or any improvement in the function 
of respiration. Often at a very early stage of Cholera, leeches 



65 

cannot draw blood from the skin; when the sweat is thin, it is 
usually poured out in large quantities from the whole surface 
of the body, but when thick or clammy, it is more partial, and 
generally confined to the trunk and head. The action of the 
vapour and hot baths, seems unquestionably to increase the 
exudation or secretion from the skin: and the application of 
dry heat, as the natural temperature of the skin augments, ap- 
pears to restrain these discharges. The perspiration or mois- 
ture is often free from odour; at other times it has a fetid, sour, 
or curdy smell, which has been said to be peculiarly disagree- 
able, and to " hang about the nostrils" of the byestander. 

That remarkable shrinking of the features of the face, which 
has acquired the emphatic term of the " true Cholera counte- 
nance," appears in every case not quickly cut short by medi- 
cine. This expression of countenance, which conveys so truly 
that of death itself, connot be mistaken, and by an attentive ob- 
server it will be perceived that a similar shrinking takes place 
throughout the limbs, and all the projecting parts of the body. 

Respiration is not usually interrupted in the early stages of 
Cholera. In many cases terminating in death, respiration has 
gone on in its mechanical part, with little or no interruption, 
excepting that it becomes more and more slow. Numerous 
cases, on the other hand, are noticed, occurring especially in 
Europeans, where the interruption of respiration was most dis- 
tressing, and could only be compared to the most violent at- 
tacks of asthma. Although the breath is stated, in many re- 
ports, to have been deficient in heat, it is not clear that this is 
a general symptom, nor is it understood that this coldness is 
more particularly observed in cases of difficult and laborious 
respiration, than in those where the function seemed to be at 
least mechanically performed without interruption. 

No symptoms of Cholera are so uniform in their appearance 
and progress, as those connected with the blood and its circu- 
lation. It is established by undoubted evidence^ that the blood 
of patients attacked with Cholera, is of an unnaturally dark 
colour and thick consistence. These changes in the circulation 
of the blood, are likewise fully proved to be in direct ratio with 
the duration of the disease. 

In a great majority of the reports of the physicians in India, 
it is stated unequivocally, that after a certain quantity of dark 
and thick blood has been abstracted, it is usual for its colour to 
become lighter, and its consistency less thick, and for the cir- 
culation to revive — such appearances always affording ground 



66 

for a proportionally favourable opinion as to the termination 
of the case. In many instances, however, no such changes have 
been observed to accompany the operation of bleeding, and 
yet the result of the case was favourable. The blood is gene- 
rally found to be less changed in appearance, in those cases of 
Cholera which have been ushered in with symptoms of excite- 
ment, than where the collapsed state of the system has occur- 
red at an early period. The blood has been occasionally found 
on dissection, to be of as dark colour in the left, as in the right 
side of the heart — affording reason for believing that in the 
whole arterial system, it was equally changed. The temporal 
artery having been freqently opened, the blood was found to be 
dark and thick like the blood of the veins. 

In the natives of India, in whom respiration is pretty gene- 
rally free, until the very last stage, the colour and consistence 
of the blood in the instances in which venesection was performed, 
has been very uniformly found to be dark, whether excessive 
discharges prevailed or not. In the majority of cases, the se- 
cretion of urine is diminished — and in violent cases it is en- 
tirely suspended throughout the attack. 

When medical aid is early administered, and the consti- 
tution of the patient is otherwise healthy, the recovery from an 
attack of Cholera is so wonderfully rapid, as perhaps to be de- 
cisive of the disease being essentially unconnected with any 
very decided morbid change in the several organs of the body. 
In the natives of India, in whom there is ordinarily very little 
tendency to inflammation, the recovery from Cholera is gene- 
rally so speedy and perfect, that it can only be compared to re- 
covery from fainting, colic, and diseases of a similar character; 
but in Europeans, in whom there is a much greater tendency to 
inflammation, and determination to some of the internal or- 
gans, the recovery from the disease is by no means so sudden or 
perfect; on the contrary, it is too often complicated with affec- 
tions as various, as the diseases of various internal organs are 
known to be in India. The most frequent of the sequelae of 
Cholera are affections of the intestines, of the brain, of the liver, 
and of the stomach. When Cholera, however, is of long con- 
tinuance, and when the congestions appear to have been tho- 
roughly established, few, either Europeans or natives, who out- 
live the attack, are restored to health without considerable dif- 
ficulty. It has already been remarked, that recovery from an 
attack of Cholera, is indicated by the return of heat to the sur- 
face of the body and rising of the pulse; a deceitful calm, how- 



67 

ever, sometimes attends these favourable appearances, which too 
often mocks our hopes and expectations, and, on the contrary, 
patients have been observed to remain for one, two, and even 
three days, in a state of the greatest collapse, and yet, contrary 
to all expectation, have recovered. 

The tendency to death in Cholera consists in a general sus- 
pension of the natural, and gradual cessation of the vital func- 
tions, rather than in the establishment of morbid actions. 
Cases have been remarked, where the vital functions have been 
more suddenly overcome, and where death took place, before 
the usual development of the symptoms of the disease. Fatal 
terminations likewise occur from topical inflammations super- 
vening, as of the stomach, intestines, or liver. The intestinal 
canal seems especially obnoxious to the effects of Cholera — 
numbers of those attacked with it having been subsequently 
seized with dysentery. 

Such are the general symptoms of Cholera as it presented it- 
self in the different districts of India, and they correspond pre- 
cisely with those observed in the disease during its prevalence 
in Russia, Poland, the north of Europe, the Canadas, &x. This 
is proved by the history of the disease which is contained in the 
circular distributed by the Austrian Government, and the elabo- 
rate epitome of its symptoms, transmitted by Dr. Keir, of Mos- 
cow, to the British Government, and in the accounts transmit- 
ted from Montreal and Quebec. It is needless to dwell on this 
topic, with the view of establishing the identity of the symp- 
toms of the Epidemic Cholera which prevailed in Europe, with 
those remarked by the English practitioners in the Cholera of 
the East Indies. All the Russian and German reports agree, 
that in the generality of cases there w r ere the same excessive 
evacuations upwards and downwards, of a watery turbid fluid, 
the same collapse of the skin, coldness of the surface, sinking 
of the pulse, failure of the strength, lividity of the face, shrink- 
ing of the features, spasms of the muscles, sense of pain, on 
pressure on the region of the splanchnic plexus of nerves, en- 
tireness of the mental faculties, and blackness and inspissation 
of the venous blood; that in Europe, as in India, some instances 
occurred of rapid, death, with collapse and spasms, and with- 
out vomiting or purging; that in other instances chronic irri- 
tation of the bowels continued for a long time after the violence 
of the disease was broken; and that sometimes, symptoms of 
cerebral congestion supervened on the violent constitutional 
disorder which accompanied the intestinal symptoms, and 



68 

quickly terminated in coma and death, when not counteracted 
by an appropriate treatment. 

If any decided difference has been observed between the 
character of Cholera as it prevailed in India, and after its ex- 
tension into Europe, it consists merely in the gradual ameliora- 
tion of the disease; the comparatively diminished violence of 
its symptoms, its less extensive diffusion among the various 
populations it has visited, and its lessened mortality in pro- 
portion to those populations, as the disease has progressed 
westward into civilized Europe — Poland suffering less than 
Russia, Austria less than Poland, Prussia less than Austria. 

That, however, the Eastern and European Cholera are sub- 
stantially the same disease, every circumstance with which we 
are acquainted, tends fully to establish. We have also the evi- 
dence in favour of its identity, of various physicians of emi- 
nence who have witnessed the Cholera both in India and Eu- 
rope. 

In our description of the symptoms characteristic of an in- 
vasion of Cholera, we have not included those of the stage of 
reaction or anastasis. — Our account would, however, be incom- 
plete, were we to omit drawing the attention of our readers to 
the fact, that Cholera Asphyxia, declared and unmitigated Cho- 
lera, ought rather to be regarded as a stage of fever— -too often, 
indeed, a violent and fatal one, than as a separate disease. — The 
forming stage is marked generally by diarrhoea and some other 
disturbances of function. The third stage, that of reaction, 
corresponds with the febrile reaction after the chill of inter- 
mittent fevers, or still more, after the stupor, coma, &c. of per- 
nicious or malignant intermittents, as they have been termed. 
In both cases, the violent or distinct asphyxia of Cholera, and 
coma of intermittent fever, will kill — in both escape from these 
may be followed by fever and phlegmasia, which will often de- 
stroy the patient. 

Mr. Searle, a judicious writer, who witnessed the disease 
both in India and Poland, observes that " Cholera was generally 
based upon, or succeeded by, fever of a bilious inflammatory 
type — in Europe, of a low remittent or typhoidal character. In 
Europe, the choleric symptoms were less marked than in 
India, and the succeeding fever : evinced less of simple re- 
action. 

"I have said remittent, though the first few days I have 
generally found it to be intermittent; coming on daily at about 
the same hour, preceded by coldness of the extremities, quiver- 



69 

ing of the lip, and depression of the circulation: but from the 
excitement of inflammation, which but too frequently becomes 
developed in the organs previously congested, the intermissions 
become imperfect, and in consequence, it assumes a remittent, 
and, from the conjoint debility, a typhoidal form." 

Almost all the cases in Poland, which were neglected or ill- 
treated at the beginning, lapsed into this form of fever. This 
is a strong proof that the choleric symptoms are only a stage or 
form of fever. The following passage is important. 

" In reference to the foregoing, and in exhibition of the con- 
nexion that subsists between Cholera, fever, and dysentery, I 
would add the notice of a milder species of the disease, which 
was, in the month of August, exceedingly prevalent at War- 
saw, and where fever and dysentery are, I was informed, an- 
nually at the same season extremely common. The following 
is the best account I could collect from my patients of its insi- 
dious mode of attack. A sense of fulness at the praecordia, of 
languor and incapacity to exertion — mental or bodily, occasion- 
ally with giddiness or headache; the latter, however, was often 
attended with an obscure form of fever, and only felt at some 
particular hour of the day; a slimy, coated, white, or furred 
tongue, and which appeared occasionally to be swollen, being 
indented along its edges by the teeth; or otherwise, an unu- 
sually clean, smooth, and red tongue; lips pallid, or of leaden 
hue; eyes often of a pearly appearance, and surrounded with a 
brown circle; the countenance sallow; appetite frequently but 
little impaired, though the digestion was in general imperfect, 
evinced by flatulence and distention after a meal. Bowels at 
first constipated, succeeded, however, in general, by relaxation, 
and this, when attended with inflammation, terminating not 
unfrequently in bloody muco-purulent evacuations, or, in other 
words, in dysentery. 

"The preceding symptoms, fluctuating with the weather and 
contingent circumstances, may continue two, three, or more 
weeks; the individual feeling that he is unwell, but not attach- 
ing any importance to his condition, till the depressing influ- 
ence of the atmosphere, preceding or accompanying wet wea- 
ther, or an attack of indigestion, succeeding to the use of some 
improper article of diet — as potatoes, cabbage, sallad, or the 
like, or drinking too freely of some cold fluid, or fatigue, or 
exposure to the sun, or cold — develops the attack of Cholera, 
coming on by purging, or vomiting, succeeded by cramps in 
the legs, lividity of countenance, cold skin, and feeble pulse: — a 

I 



70 

condition which, if the patient recovers, is almost invaria- 
bly succeeded by fever, of an intermitting or remitting type, 
coming- on daily or oftener, and generally unpreceded by any 
very marked cold stage, further than a sense of shuddering, tre- 
mor, or quivering of the lip, and depression of the circulation. 
An attack of this kind, it must be obvious, is nothing more 
than one of fever, based upon torpor of function, and conges- 
tion of the liver and chylo-poietic organs: and attributable to 
the continued respiration of an impure atmosphere of a milder 
degree than ordinarily gives rise to Cholera, such as results 
from the imperfect ventilation of the town, and foul state of the 
drains: or in persons otherwise situated, from some swamp or 
filth in the neighbourhood of their abodes." 

The views which we hold of Cholera, as properly a stage of 
Cholera fever, are further corroborated in the following ex- 
tracts from two letters published by Dr. Negri, an intelligent 
Italian physician, residing in London. They go to show the 
great resemblance, if not identity between the malignant Cho- 
lera and the pernicious fevers, described by Torti, more than 
120 years ago. 

" Speaking of the character of those fevers, Torti says, ' the 
pernicious intermittent, more especially that wearing the ter- 
tian form, kills about the beginning of the paroxysm, when it 
is accompanied with violent bilious vomiting and purging of 
bilious humours, equally vicious both in quality and quantity, 
being sometimes clear, at others coloured, and occasionally of 
inspissated greenish bile; to which vomiting and purging are 
added, hiccup, a hoarse sonorous voice, hollowness of the eyes, 
pain of stomach, small sweat upon the forehead, weak pulse, 
and cold or livid extremities — in one word, all the symptoms 
which usually mark cholera morbus; from which, however, this, 
as it were, choleric affection, is to be distinguished; since it is a 
mere symptom, of the fever, the period of which it follows, as a 
shadow does a body..' " 

Torti describes a u febris perniciosa cholerica" in which the 
patient becomes nearly exhausted, " universally chilled, lies su- 
pine, with a pulse almost abolished, sunken eyes, and difficult 
breathing." Dr. Negri also quotes from Mercatus, physician 
to the King of Spain, who describes a pernicious tertian, pre- 
senting the same symptoms as Cholera, and frequently lapsing 
into a pernicious fever. The following passage from Morton, 
quoted by Dr. Negri, will be read with interest at the present 
moment. 



71 

a Among- the innumerable symptoms attending these fevers, 
there is none which may not rise to a great height, endan- 
gering the life of the patient, so that typhus fever (marked in 
its stages of cold, heat, and sweating) supervenes, rendering 
it impossible to be distinguished by the urine, temperature, 
pulse, or indeed any other means; but, concealed under the 
appearance of cold, vomiting, diarrhoea, cholera morbus, cholic, 
or other disease, not unfrequently misleading the physician." 

Torti, as well as Morton, exhibited bark as early as possible, 
and in large quantities, and this practice is recommended by 
Dr. Negri, from experience of its good effects in the malarious 
fevers of Italy. Dr. Negri comes to the conclusion " that the 
malignant cholera of our days belongs to the same class of dis- 
eases which was seen by Mercatus in Spain, Torti in Italy, and 
Morton in England." He suggests the administration of bark 
in large doses and early in the disease. 

The following case from Torti presents (says Dr. James 
Johnson) a complete picture of the Sunderland cholera. 

" When I reached the patient, he had been several hours 
labouring under the disease. I found him universally cold as 
marble, with the pulse altogether, if I may so say, absent, 
breathing laboriously, and having a leaden-coloured counte- 
nance. There was some torpor, but no confusion of intellect, 
(he never mentioned delirium) and his urine was secreted in a 
small quantity. I prescribed the bark in large doses. A gentle 
heat soon pervaded his entire frame; the pulse gradually return- 
ed; the respiration became natural; the face lost its leaden hue; 
the urine was secreted in its ordinary quantity, and in three 
days he was quite recovered." 



72 



CHAPTER IV. 



Of the Morbid Appearances detected in the Bodies of those who have died of 

Cholera. 

For the information of our professional readers, we present the 
following description of the morbid appearances detected after 
death, in the bodies of those who have died of Cholera. The 
appearances ordinarily discovered in India are given with con- 
siderable minuteness in several of the medical reports. The 
following description is condensed from the very able Report 
drawn up by Mr. Scott for the Madras Medical Board. 

The external appearance, after death, of European subjects, 
closely resembles that which they exhibited whilst labouring 
under the Cholera. The surface is livid, the solids shrunk, 
the skin of the feet and hands corrugated. There exists no 
uncommon tendency in the body to putrefaction, nor any cha- 
racteristic fetor from the abdominal cavity. The cavities of 
the body lined with serous membranes, as well as these mem- 
branes themselves, presented no particular morbid appearances. 
The cavities indicated have almost uniformly been found in 
a natural state, or the deviations from that state which were 
met with, had manifestly no connexion with Cholera. The 
surfaces which are lined or covered with mucous membrane, 
on the contrary, very generally exhibited signs of disease. 

The lungs have not unfrequently been found in a natural con- 
dition, even in cases where much oppression of respiration had 
existed previously to death. Much more generally, however, 
they were found to be gorged with dark blood, so thick that they 
have lost their characteristic appearance, assuming more that 
of liver or spleen^ or they were in an opposite condition, — that 
is, collapsed into an extremely small bulk, and lying in the hol- 
low on each side of the spine, leaving the cavity of the thorax 
nearly empty. This has been supposed to have arisen from the 
extrication of a gas, but on piercing the thorax of the dead 
body under water, no gas escaped. The blood found in the 
lungs has been always black. The heart, and its larger vessels 
were found to be distended with blood, but not so generally as 



73 

the apparent feebleness of their propelling power, and the evi- 
dent retreat of the blood to the centre, would have led us to 
expect. The engorgement of the right cavities of the heart with 
blood is not peculiar to Cholera, but in some cases the left ca- 
vities were found filled even with dark or black blood, which 
we may consider a morbid appearance more peculiar to this 
disease. 

In the abdominal cavity, the peritoneal covering of the visce- 
ra presented seldom any morbid appearances; the morbid ac- 
cumulation of blood in the vessels of the viscera, imparting to 
it, however, an appearance of turgidity and blueness, which 
was occasionally evident on its exterior surface. Where the 
patient has lingered long before death, this membrane occa- 
sionally exhibits traces of inflammation. In other cases, the 
whole intestinal tube presented a blanched appearance, both ex- 
ternally and internally. The stomach and intestines generally 
preserved their ordinary size. The omentum was not sensibly 
affected. So various were the morbid changes in the stomach, 
that upon them no pathological conclusions could be founded. 
This organ was rarely found empty, or much contracted, nor 
was any appearance of spasmodic stricture of the pylorus often 
detected. It did, however, sometimes occur. The contents 
of the stomach appeared to be chiefly the ingestae in an altered 
state; in some cases a greenish, yellow, or turbid matter was 
found. Various appearances, either of active inflammation, or 
a congested state of the vessels, were noticed, sometimes in one 
part and sometimes in another. The parts seemed as if they 
were sphacelated, thickened, softened, and friable, — and, in 
short, exhibited so great a variety of appearances from a per- 
fectly natural state, to the most morbid condition, that no par- 
ticular light is shed by them on the nature of the disease. 

The intestinal tube was sometimes collapsed, but oftener 
more or less filled with gas; distended in some points, into bags 
or pouches, containing a whitish, turbid, dark, or green colour- 
ed fluid; and in others presenting the appearance of spastic 
constriction. The intestines contained no fcecal or other solid 
matters, but very commonly large quantities of a. congee looking 
fluid, or of turbid serous matter. The duodenum and occasional- 
ly the jejunum, were found loaded with an adherent whitish or 
greenish mucus, at other times they were found denuded, as it 
were, of their natural mucus, and often they were perfectly healthy. 
Traces of bile in the intestines, or of any substances apparently 
descended from the stomach, were exceedingly rare. Sangui- 



74 

neous congestion, and even active inflammation, are stated to 
have been more common in the bowels than in the stomach; 
but, on the other hand, instances were very numerous where no 
such indications were detected. The thoracic duct is stated to 
have been found empty of chyle. The liver was commonly 
gorged with blood, but not always; the gall bladder was almost 
universally found to contain bile, and in the great majority of 
cases, was even completely filled with it. As is usual with 
this secretion in cases of retention, it was of a dark colour. 
Very different states of the gall ducts have been described; 
cases of constriction and impermeability seeming to be equally 
numerous with those of an opposite character. The urinary 
bladder was found, we may say universally, without urine, and 
very much contracted. The mucous membrane of the bladder 
and uterus, have been found coated with a whitish coloured fluid. 
In the spleen, nothing unusual was detected. The vessels of the 
mesentery were very generally found to be loaded with blood. 

In the head, appearances of congestion, and even of extrava- 
sation, were frequently observed; but not so uniformly, nor to 
such an extent, as to require any particular notice. Only one 
case has been given, Avhere the state of the spinal marrow was 
examined; and in that, indications of great inflammation were 
detected in its sheath; the case in which this occurred was, 
however, in some degree, a mixed one. 

It will be useful, in many points of view, to compare the 
foregoing result of the autoptical examinations by the physi- 
cians of India, with the morbid appearances detected after 
death by the physicians of the north of Europe. For this pur- 
pose, we present the following extract from the memoir of Dr. 
Keir, of Moscow. 

In the bodies of those who have died of the Cholera, the ex- 
tremities in general were more or less livid and contracted, and 
the skin of the hands and feet corrugated : the features sunk and 
ghastly. On opening the cranium, the blood vessels of the brain, 
as well as of its membranes, were more or less turgid, especial- 
ly towards its base. The arachnoidea had sometimes in seve- 
ral places lost its transparency, and adhered to the pia mater, 
A fluid in considerable quantity was occasionally found effused 
between the convolutions of the brain, and more or less of se- 
rum in the lateral ventricles. The blood-vessels of the verte- 
bral column and spinal chord were more or less loaded with 
blood, which was, also, sometimes effused between its arachnoid 
and pia mater; partial softening of the substance of the chord wa^> 



15 

sometimes met with, and marks of inflammatory congestion in 
the larger nerves. The lungs were generally gorged with dark 
coloured blood; the cavities of the heart were filled with the 
same, and frequently contained polypous secretions. In all the 
dissections at which Dr. Keir was present, very dark coloured 
blood, which, when spread on a white surface, resembled in co- 
lour, that of the darkest cherry, was found in the arch of the aorta, 
and in other of the arteries. The state of the abdominal organs va- 
ried considerably; the stomach and different parts of the intestines 
were frequently found to be partially, but considerably contracted; 
the internal surface of the stomach sometimes seemed to be little 
affected; a whitish or yellow fluid matter, resembling the evacu- 
tions was frequently found in different parts of the alimentary 
canal, which now and then contained a good deal of gas; in 
other cases, both stomach and intestines bore marks of conges- 
tion, and of a sub-inflamrnatory state, varying from dark co- 
loured spots, of small extent, to several inches, affecting the 
whole internal circumference of the intestine; the colour of 
these parts, also, varied considerably, from dark coloured ve- 
nous congestion, to light rose coloured inflammation. In one 
case, the internal surface of the stomach was so strongly and 
so generally tinged of a very dark colour, that it might easily 
have been mistaken for gangrene. On exposing the stomach 
between the eye and the light, it was evident that there was 
neither gangrene nor solution of continuty, but that the dark 
colour proceeded from a very general and great congestion of 
very dark coloured blood, in the vessels of the organ. The 
subject of this case was understood to have died, with symp- 
toms of a typhoid character, after suffering from the usual 
symptoms of Cholera. Excepting in this case, which was evi- 
dently one of congestion, and not of inflammation, Dr. Keir saw 
nothing in the morbid appearances from which a conclusion 
could be drawn that inflammation was a very general phenome- 
non in the alimentary canal, or a common cause of death, how- 
ever it might, by its presence in the second period of the dis- 
ease, add to the general irritation, or even, as a consequence of 
preceding congestion, be itself occasionally the cause of the 
fatal event. Both the stomach and bowels were frequently of a 
paler colour than natural, as well internally as externally; but 
neither thickening nor condensation from inflammation, nor ul- 
ceration, destruction of substance, nor abscess, was present in 
any of the dissections witnessed by Dr. Keir. The liver was 
generally pretty full of dark coloured blood; the gall bladder 



76 

frequently much distended with tenacious ropy bile, of a dark 
yellow or green colour; the gall ducts sometimes contracted, 
at others not; the appearance of the pancreas, spleen, and kid- 
neys, was various, frequently differing but little from their na- 
tural state, in other cases slightly surcharged with blood; the 
urinary bladder was always collapsed and empty; the uterus 
was in e;eneral natural. 



77 



CHAPTER V. 



Treatment of Cholera; when in time, it is not an unmanageable Disease. — Blood- 
letting. — Sinapisms and Rubefacients. Dry Frictions. Blisters. — -Dry 

Heat. — Warm Bath. — Calomel. — Opium. — Internal Stimuli. — Emetics. — Pur- 
gatives. — Enemata. — Sub-nitrate of Bismuth. — Muriate of Soda. — Drinks. — 
Secondary Stage. — A Sketch of the Several Stages of Cholera, with an Account 
of the Treatment adapted to each of these Stages. 

The Cholera has not been found to be less under the control 
of an appropriate treatment than any other disease equally ra- 
pid in its course. When remedies of a proper kind have been 
administered in the early stage of the complaint, and judicious- 
ly managed, a favourable termination has in the majority of 
cases been the result. The difficulty is to induce patients to 
apply sufficiently early for medical aid, — with the loss of a 
very few hours the chances of recovery are greatly dimi- 
nished. " If the disease," says Annesley, whose experience 
in the treatment of the Epidemic Cholera during its preva- 
lence in India, was considerable, "be taken at its commence- 
ment, or within an hour after the seizure, it is as manageable 
as any other acute disease, but the rapidity with which it runs 
through its course, requires the most active exertions before 
it can be checked, and the loss of an hour may cause the loss 
of a life."* 

The remedy, the good effects of which, in the treatment of 
Cholera, appears to have been most generally acknowledged, 
and the early employment of which is most insisted upon, is 
blood-letting. 

Bleeding from the arm in the first stage, when the pulse is 
full, and the temperature not reduced, is often sufficient to cut 
short the disease. The patient always feels immediate relief, 
particularly where the head has been much affected. The 
bleeding should be performed in a horizontal position, and the 
patient remain quiet for some time afterwards. We are direct- 
ed by Dr. Dyrsen to increase the flow of the blood from the 
arm by frictions to the surface of the body, with flannel cloths 

* Diseases of India, p. 175, 
K 



78 

wrung out of hot water, or by bleeding during immersion in 
the warm bath. 

According to Mr. Bell, " in no case in which it has been 
possible to persevere in blood-letting until the blood flows 
freely from the veins, and its colour is recovered, and the op- 
pressed chest is relieved, will the patient die from that attack 
of the disease." He directs, that when the blood has once 
begun to flow, it be allowed to escape till these changes are 
observed. The ordinary rule for the use of venesection in 
acute diseases, namely, to continue till syncope come on, is here 
inapplicable, as it is extremely difficult to induce fainting in 
patients affected with Cholera.* It is the opinion of Mr. Ken- 
nedy, that, in ninety-nine instances out of a hundred, where pa- 
tients are said to have died " despite of blood-letting," it will 
be found, upon examination, either that no blood flowed from 
the incised veins, or that it came away in drops, or in a small 
broken stream, rarely exceeding a few ounces in quantity. "On 
the contrary," he adds, " where blood was freely obtained to 
the extent of twenty or thirty ounces, and where the depletion 
was followed by proper auxiliaries, the patients have usually 
recovered."! 

The testimony of the German, Russian, and Polish physi- 
cians is equally decisive in favour of the beneficial effects re- 
sulting from blood-letting, when early resorted to in Cholera. 

The absence of the pulse is no prohibition to the use of the 
lancet, unless it be accompanied by other symptoms of great 
debility, and the system has been exhausted by previous evacu- 
ations, and the surface is covered with a cold clammy sweat. 
Even under such circumstances, many attest the advantages 
of blood-letting, especially when preceded by sinapisms, the 
application of dry heat and frictions to the surface, and dif- 
fusible stimulants internally. In some cases of Cholera, Dr. 
Lefevre remarks, the pulse ceases to beat very early, but upon 
opening a vein the blood flows slowly at first, gradually the 
current becomes fuller and stronger, the pulse beats very sen- 
sibly, and the heart thus relieved is enabled to continue the 
circulation. 

The only cases in which bleeding would appear of doubtful 
propriety, during the first stage, are those occurring in old, 
debilitated subjects, and in constitutions completely broken 
down by intemperance. 

* Treatise on Cholera, p. 105. et seq. i History of Cholera, p. 169. 



79 

When blood cannot be drawn from the arm, and the spasms 
continue — when severe pain and burning heat are felt at the 
epigastrium — when the skin is cold, and deluged with a cold 
clammy sweat, and when there is oppression at the chest, and 
difficulty of breathing, excessive pain and confusion of the head, 
with great intolerance of light, no pulse, or a very indistinct 
one, and a cadaverous smell from the body, Mr. Annesley ad- 
vises the immediate application of twenty or thirty leeches to 
the umbilicus and scrobiculus cordis, in conjunction with fric- 
tions with turpentine externally, and the calomel pill internally, 
while at the same time leeches are to be applied to the temples 
and base of the scull. 

In the advanced stage of the disease an opportunity is some- 
times afforded for the abstraction of blood. This, according 
to Annesley, is marked by a struggle or effort of the circulation 
to overcome some resisting power, and is a most auspicious 
symptom, which should never be overlooked: as soon as it oc- 
curs, bleeding, directed with great judgment, should be resort- 
ed to.* 

Dr. Lefevre objects to leeches in Cholera, and, we think, with 
propriety, from the slowness of their operation; he advises cup- 
ping as preferable. 

The patient, after bleeding, should be warmly covered with 
bed clothes, and allowed to remain perfectly still for a short 
period. 

Sinapisms and Rubefacients. — These are among the most effi- 
cacious means adapted to the cure of Cholera. " It may be 
said of them, that they are indispensable, and there is hardly 
any stage of the disease in which they may not be employed 
with advantage — so long as the disease endures, so long will 
their use be indicated, and they should be repeated continual- 
ly." The pain in the bowels, and even the sickness, are often 
instantaneously relieved by the application of a large sinapism 
over the abdomen, and much pain is saved the patient, if it be 
applied early.f In violent cases of the disease the application 
of sinapisms to the ancles, wrists, calves of the legs, inside of 
the arms and thighs, and along the spine, is recommended in the 
strongest terms in various treatises on the Cholera, and we feel 
persuaded, from the beneficial effects which we have seen result 
from the practice, that it is one which should never be neglect- 

" Diseases of India, p. 156. et seq. 

t Lefevre, Obs. on the Nat. and Treat, of Cholera, p, 58. et seq. 



80 

cd — it would be as well probably to defer, however, the sina- 
pisms until the full effects of dry frictions have been tested. 
When the skin has been excoriated by the use of sinapisms, 
anodyne fomentations, or even pulverised opium, sprinkled 
over the tender surface, will often be useful in relieving pain 
and nausea.* 

Dry Frictions are recommended as remedies of great efficacy 
in all cases of Cholera — they are best adapted to, and have been 
found most beneficial in the early period of the attack. " The 
object of friction is two-fold. 1st. To restore the circulation 
in the part, and the heat that is dependent upon it. 2d. To in- 
troduce remedies into the system by absorption. The first may 
be effected by mere dry rubbing with the hand, or a warm flannel, 
or the flesh brush, and, if persisted in, will often restore the 
circulation to the extremities, which were previously cold and 
senseless; but it requires great perseverance, and long conti- 
nuance, for it is necessary to keep up the circulation after it is 
restored; hence it can only be recommended in those circum- 
stances where there are plenty of attendants to wait upon the 
sick. Various liniments have been proposed to aid the effects 
of friction, but they may be superseded by steady rubbing with 
the hand, which should be sprinkled occasionally with a little 
powdered starch, or a little camphorated oil, to prevent abra- 
sion. Where proper and effectual rubbing cannot be maintain- 
ed, stimulating liniments should be employed, — because little 
rubbing will suffice, and the effect will be more permanent. 
The liniment composed of camphorated spirit and ammonia 
will answer every purpose. When the spasms are severe, Mr. 
Annesley prefers the spirits of turpentine as an embrocation. 
Embrocations with ardent spirits are evidently improper, as 
their rapid evaporation will have a tendency to increase the 
coldness of the surface. 

Medicines may be introduced into the circulation by frictions 
— and thus certain indications fulfilled, when the stomach is in 
too irritable a condition to retain the appropriate remedies. 
Especially may local pain and spasm be alleviated by frictions 
with opium, hyosciamus, and other narcotics, in the form of 
liniment or unguent.f 

Blisters would appear to be less proper than sinapisms, in 
the first stage of the Cholera, from the slowness of their action. 

* Lefevre, Obs. on the Nat. and Treat of Cholera, p. 58. et seq, 
I Lefevre on Cholera, p. 60, et seq. 



81 

In the second stage, however, they may be demanded, should 
local congestions or chronic inflammation occur. 

Dry Heat. — This remedy is strongly recommended by many 
of the practitioners who have witnessed the Cholera in the 
north of Europe. Mr. Kennedy, also, recommends it in the 
first stage of the disease, after bleeding, the warm bath, and 
the other remedies which are immediately demanded. He re- 
marks, "as soon as the cramps are subdued, or have received a 
decided check, the patient, with all possible expedition, should 
be removed from the bath, and placed between dry heated 
blankets. Dry warmth should be further afforded by sur- 
rounding his body and limbs with bags of heated sand. Here 
dry heat, be it remembered, is the remedy, and not the sand 
which contains it. On this principle, bottles of hot water roll- 
ed in flannel, have been employed, and, also, hot ashes, bran, 
oat meal, Sec. Sec. A more efficient mode of applying dry heat, 
than any of these, may suggest itself; but occasionally, to pre- 
vent loss of time, we must take the first that offers."* 

Warm Bath. — In regard to the good effects of this remedy, 
there is some discrepancy of opinion among the different writers 
upon the treatment of Cholera. While it appears to have been 
viewed by many of the East India surgeons, and most of the 
Russian and German practitioners, as a remedial agent of great 
power, rousing the dormant activity of the circulation, and de- 
termining the blood to the superficies of the body, others have 
objected to its use entirely. In St. Petersburgh, according to 
Dr. Lefevre, the use of the warm bath was, at the commence- 
ment of the epidemic, almost universal; but it soon fell into 
disuse, and, upon the whole, he believes that its use has been 
found prejudicial. This, he conceives, arises from the exhaus- 
tion produced by transporting the patient from his bed to the 
bath — and by the effects of the latter, and from the pain and 
uneasiness which the patient experiences by his " sudden tran- 
sition from cold to heat." These objections appear to us, 
however, to be due rather to the injudicious manner in which 
the bath has been administered, than to the bath itself. Dr. 
Lefevre admits that if employed at the commencement of the 
attack, " when the excitement is still considerable,' 5 it will 
often be found serviceable, and prove very comfortable. He 
considers, however, the vapour bath, dry heat, and frictions, to 
be preferable. Others recommend the substitution of hot fo- 

* Kennedy on Cholera, p.. 176 



82 

mentations, poultices, &c. The evidence, however, in favour 
of the use of the warm bath, in the treatment of Cholera, is of 
too strong a character to allow of its being slightly rejected. 
On this subject there is much good sense in the following re- 
marks of Mr. Kennedy: — "In the treatment of Cholera, several 
physicians limit their encomiums to the warm bath; others 
extol the vapour bath to the exclusion of the former; while lat- 
terly, a third authority* maintains that a hemp seed poultice is 
better than either. A grain of reflection might have convinced 
the three parties that they were divided on the merits of a 
name alone. The medical virtue is the same in all, and it con- 
sists simply in the application of heat and moisture to the sur- 
face of the body. The question to be determined is the effect 
which these remedies are, individually, capable of producing, 
in a given time, upon the patient, and where there is a choice 
at command, we should select the strongest one of the number. 
Now, the warm bath is by far the most effective and convenient 
agent of the class to which it belongs; it communicates heat 
more rapidly to the body than either the vapour bath or the 
poultice, and the relaxing power of its moisture is commensu- 
rate. It should, therefore," he adds, " be preferred in those 
stages of the disease where the use of moist heat is indicated — 
from its superior power, a greater degree of caution, it should 
be recollected, is required to prevent its being too long conti- 
nued or misapplied." Mr. Kennedy considers the proper pe- 
riod for the use of the warm bath to be the early stage of the 
disease.f 

The following are the directions of Dr. Harnett, one of the 
British Medical Commission at Dantzic, for the use of the 
warm bath. 

" It has been found necessary to guard against the indiscri- 
minate use of the hot water and vapour baths, in hot weather, 
after perspiration has broken out, and above all, in the clammy 
stage of the disease, and after marked venous congestion has 
taken place, when it seems to increase the latter, which is par- 
ticularly observable in the brain and heart. The bath should 
be used either in the critical moment at the beginning of the 
disease, or, at farthest, instantly after, if admissible even then. 
To obviate the determination of blood to the head, cold appli- 
cations ought to be occasionally applied to it, while the patient 

* Warsaw Committee of Health. 
t Kennedy on Cholera, p. 166. 



83 

is in the bath. The patient should be most gently, and other- 
wise judiciously placed in the bath, with respect to the gra- 
dually inclined position of his body, and the due support of the 
head, neck, and shoulders; and the immersion or subjection 
should be short; merely long enough for the positive commu- 
nication of heat and its effects; when he ought to be as gently 
and judiciously taken out, well wrapped up in hot blankets, 
promptly laid in a bed, and gently rubbed with warm, dry, 
coarse, but soft thread towels, all over; and wiped dry as fast 
as the clammy sweat oozes out. There is much handy and 
careful personal management requisite, in this essential part of 
the treatment."* 

Calomel. — The exhibition of calomel in Cholera is a prac- 
tice which has been pursued by a majority of the English 
surgeons in India, and it is spoken highly of by such of them 
as have witnessed the disease in the North of Europe. In many 
instances the use of calomel has been carried to an enormous 
extent — doses of a scruple to half a drachm being considered 
the smallest which are adapted to the disease; others, howe- 
ver, have condemned the use of the remedy, to this extent, and 
recommend it to be given in smaller doses, frequently repeated, 
and in general combined with opium. The evidence which is 
advanced in favour of the beneficial effects of calomel under 
both modes of administration might at first view appear per- 
fectly conclusive; but in making up our mind on this subject, 
we are to recollect that in almost all the cases which are ad- 
duced where the practice is supposed to have been eminently 
successful, other important remedies have at the same time 
been employed — especially bleeding — frictions and stimulating 
applications to the surface, and very commonly the warm bath 
also. Upon the early and judicious employment of the last 
mentioned remedies, nearly all the writers agree that the cure 
of the disease mainly depends; by many they are supposed to 
be of themselves fully sufficient, and that the various internal 
remedies that have been resorted to are either useless or abso- 
lutely pernicious. Among the physicians of Russia, Poland, 
and Germany, there are but few who recommend the use of 
calomel at all, and the majority denounce, in very decided 
terms, its employment in the early stages of Cholera, or to the 
extent to which it was carried by the practitioners of India. In 
Warsaw, the result of experience showed, according to Dr. 

* Reports to the British Government, by John Harnett, M. D, < 



84 

Hille, that whether in large closes, or in small ones, frequently 
repeated, the calomel did more harm than good, and hence its 
use was either entirely abandoned, or it was given in a single 
dose of a few grains combined with opium.* Dr. Gibbs, writ- 
ing from St. Petersburg says, expressly, that scruple and half 
scruple doses of calomel would not do thereat And Dr. Le- 
fevre very properly remarks, that small doses combined with 
opium can be of no use in the first stages. " In slight cases, 5 ' 
he adds, " where the quantity of opium is sufficient to allay 
the spasmodic action, whilst time is allowed for the calomel to 
act gradually, the combination, however, may be of service: 
but it must share the same fate as all the vaunted nostrums 
which, when administered indiscriminately, lose even the merit 
to which they are really entitled.^ In Dunaburg, no calomel 
was administered, and of 745 cases, many of which were in the 
last stages of the disease when first seen by the physician, only 
75 terminated fatally.§ 

Opium. — No remedy has been proposed in the treatment of 
Cholera, which has so great a mass of testimony in its favour as 
opium. Nearly all physicians, whatever may be their opinions 
as to the nature of the disease, employ it in some shape, 
at one period or other of the disease. By some it is recom- 
mended in the largest possible doses, by others, however, when 
given in smaller doses, it is considered much more efficacious, 
and less liable to produce injurious consequences. Mr. Orton 
considers it " probable that a single dose of opium alone, given 
at the very commencement of the disease, would be found, in 
a great majority of instances, to put an effectual check to its 
progress." He warns us, however, against an excessive use 
of the remedy. When given in large doses, its secondary, 
perhaps its immediate effects, he thinks are an increase of that 
oppression of the vital powers, which so strongly marks the 
intense degrees of the disease. He prefers giving it in sub- 
stance to the tincture, as less liable to be rejected. Four grains 
he recommends for the first dose, to be repeated, if a favoura- 
ble change is not produced, in diminished doses, at intervals, 
of from three to six hours.|| The Polish and a few of the Ger- 

* Ueber die Assiatische Cholera, p. 115. 
t Observations of Cholera, Ed. M. & S. Jour. p. 396. vol. 36. 
| Observations, &c. on Cholera, p. 72. et seq. 

§ Ueber die Cholera in Dunaburg von Dr. Ewertz, Jour. f. Chirur. u. Au- 
genheilhunde, p. 313. vol. 17. 

|| Essay on the Epidemic Cholera, p. 304. et seq 



85 

man physicians object, however, to the exhibition of opium in 
Cholera. The brain and spinal marrow tend so rapidly to as- 
sume in this disease a congestive condition, remarks Dr. Hille, 
that opium, even in small doses, from its tendency to accelerate 
and augment this morbid state of those organs, becomes a very 
doubtful remedy. This was likewise the opinion of most of the 
physicians at Warsaw* and at Riga.f 

Internal Stimulants. — The exhibition of ether, brandy, am- 
monia, and other stimulants, we find to be very generally re- 
commended, especially in the advanced stage of the disease. 
They are directed to be continued until reaction is fairly esta- 
blished, after which they are to be gradually relinquished. In 
the early stage of the disease we have less evidence of their 
good effects than during that period in which the clam- 
my sweat, icy coldness of the surface, scarcely perceptible 
pulse, and sunken countenance, indicate a state of collapse, 
which, if not speedily removed, the loss of the patient is inevi- 
table. Many would appear to have employed the most power- 
ful stimulants even from the very commencement of the attack, 
and with no sparing hand. This practice cannot, however, be 
too severely reprobated. — Stimulants require at all times much 
judgment and great caution in tjieir employment, or they will 
most assuredly produce far more harm than good. Mr. Bell 
very properly warns his readers against the practice so gene- 
rally adopted in India of prescribing inordinate doses not only 
of internal stimulants, but likewise of calomel and opium. He 
maintains that some individuals, in whom the disease appear- 
ed to be checked by them at first, nevertheless eventually died 
from their poisonous operation.^ 

Emetics. — By several physicians emetics are directed in the 
early stage of Cholera " to remove crudities from the sto- 
mach." According to Dr. Lefevre, they were found productive 
of very little benefit. Their efficacy, as we shall hereafter 
show, must greatly depend upon the stage of the disease, and 
the constitution and prior habits of the patient. 

Purgatives. — Though considered by some as indispensable 
remedies in the treatment of Cholera, they do not appear, with 
the exception of calomel, to have been very generally employed 
until after the more pressing and violent symptoms of the dis- 
ease have been subdued. At this particular juncture it is very 

* Beobachtungen liber die Cholera, p. 116. 

t Nachricten Rigaer aertze Uber die herrschende Cholera Epidemic 
p. 330. \ Treatise on Epidemic Cholera. 

L 



86 

generally conceded that they have been productive of the best 
effects. " They are indicated so long as the bowels do not per- 
form their functions regularly, and the motions have an unu- 
sual appearance; nor is there any fear of reproducing the dis- 
ease by their continuance, so long as we take these marks for 
our guide. It is much more likely to recur from neglecting 
to administer them; and the quantity of unhealthy matter which 
is often evacuated for a long time after the disease has been 
subdued, warrants the assertion." Such is the experience of 
Dr. Lefevre in regard to the use of purgatives. — Mr. Orton 
pronounces them indispensable after the favourable crisis for 
preventing or removing the train of fatal sequelae which so 
frequently attend the disease. They are found to produce co- 
pious discharges of vitiated bile and faeces. By Mr. Annesley 
nearly the same statement is made. Until the dejections became, 
under the use of purgatives, of a blackish grey colour, sub- 
stantial and tenacious, the latter gentleman never considered 
that he had made much advancement in the cure of his patients. 

" A full dose of calomel," remarks Dr. Lefevre, " is often use- 
ful in the beginning of the convalescence, as it acts upon all the 
secretions — but the simple purging, which is so requisite after 
this disorder, is best effected by small and repeated doses of 
castor oil." The virtues of the latter have indeed been extolled 
in a very positive manner, by the physicians both of India and 
Europe. " The success under its use was very considerable, and 
there seems," says Mr. Scott,* " to be sufficient evidence to 
warrant a more extensive trial." It is admitted on all hands, 
that purgatives which produce frequent, watery dejections, with 
griping and' tenesmus, are in the highest degree prejudicial. 

Enemata. — When the irritability of the stomach, or incessant 
vomiting, prevents the exhibition of remedies by the mouth, 
enemata appear in some cases to have been useful. From the 
great irritability of the intestines, their speedy rejection pre- 
vents, in the majority of instances, any great advantage from 
being experienced from their use in the commencement of the 
attack. In the latter stages of the disease, however, they are of 
signal service, especially in such cases as have been attended 
with much spasm, and the bowels continue sore for a long time 
after, and every motion is productive of pain. Here an enema 
composed of half a pint of flaxseed tea and ten drops of lauda- 
num produces immediate relief — administered in this manner, 

* Madras Report. 



87 

the opium is less liable to produce injurious consequences than 
when given by the mouth.* Injections per annm of hot water, 
above blood heat, have been highly spoken of in cases of 
great collapse and general coldness of the surfaces. After re- 
maining in a while, the water may be withdrawn by the syringe 
and a fresh supply introduced. Tobacco enemata have, also, 
as we shall soon see, been recommended and used. Mr. Fife 
speaks favourably of injections of mustard — they have, he says, 
promptly brought on a discharge of urine, after it had been 
entirely suppressed. 

Sub-nitrate of Bismuth. — To read the statements given by 
some of the Polish and a few of the German physicians, of the 
beneficial effects of sub-nitrate of bismuth in every case and 
stage of Cholera, we should conclude certainly that a specific 
for the malady had at length been happily discovered. More 
extended experience has shown, however, that the character 
which the bismuth at first obtained as an infallible remedy for 
Cholera was unmerited, and by many it was pronounced to be 
incapable of producing any good effects, and if indiscreetly ad- 
ministered, was mischievous. Mr. Lefevre, who has evinced not 
a little judgment in his estimate of the value of the various re- 
medies proposed in the treatment of the disease, believes that 
much good is to be derived from the prudent use of this article. 
No remedy seems to quiet the cramps and vomiting more ef- 
fectually, and when employed in moderation, it does not produce 
those unpleasant effects upon the system which follow the use 
of severer remedies. The doses administered by Dr. Leo, by 
whom the article has been principally recommended, were from 
two to four grains every two to four hours. Dr. Lefevre warns us 
to discontinue its use as soon as the vomiting and spasms have 
ceased. If this does not take place after six or eight doses, it is 
useless to continue it longer. It is proper to remark, that ac- 
cording to the testimony of Dr. Baum, great inflammation was 
detected in the bowels of those who died after the use of the 
bismuth.f 

Muriate of Soda. — Although a solution of common salt is 
praised by a few of the continental physicians as a powerful re- 
medy in Cholera, and is recommended by Mr. Searle as an eme- 
tic in the commencement of the case, we cannot say that the 
evidence in its favour is very strong. It is true we are told by 
Dr. Barry, that at St. Petersburgh, two German physicians de- 

* See Lefevre's Observations, &c. on Cholera Morbus, p. 63, et. seq. 
I Dr. Harnett's Reports to the British Government from Dantzic. 



88 

clared in his presence at the medical council," that during the 
preceding eleven days, they had treated at the custom-house 
hospital thirty Cholera patients, of whom they lost none. They 
gave two table-spoonsful of common salt in six ounces of hot 
water at once, and one spoonful of the same, cold, every hour 
subsequently."* But let it be recollected, that these gentlemen, 
as well as the others who have recommended this remedy, al- 
ways premised bleeding and other remedies, upon the impor- 
tance and good effects of which in Cholera there is but little 
discrepancy of opinion. It is thus that many remedies in this 
and other diseases, acquire a fictitious reputation, from being 
conjoined with others of acknowledged power- — when had they 
been omitted, the case would, in all probability, have proceeded 
as rapidly, or perhaps even more so, to a favourable termina- 
tion. 

We might extend this chapter to a much greater length, by a 
notice of various other remedies which have been proposed and 
strongly recommended in the treatment of Cholera by different 
writers, but the means not being afforded us by which any de- 
cided opinion as to their efficacy can be formed, we conceive it 
more prudent to confine our remarks to those most generally 
employed, and in regard to the effects of which we are furnish- 
ed with the results of a pretty extensive experience. We have 
merely in addition to the remarks already made, to say a few 
words upon the drinks proper to be allowed in this disease, and 
the general treatment demanded in its secondary stage. 

Drinks. — A strange diversity of opinion exists among the 
writers upon Cholera, as to the proper drinks to be allowed the 
patient. By some, diluents of every kind were entirely prohibit- 
ed, in consequence of a supposition that they increased the vo- 
miting. The great desire of the patient is for cold water— he 
appears to labour under the most distressing thirst, the calls of 
which, it must be evident, cannot be disregarded, without ma- 
terially increasing his sufferings, and eventually, the disease 
under which he suffers. Mr. Scott, in common with nearly all 
the best practitioners, concedes the propriety of allowing some 
bland diluent, but maintains that it should be given of tepid 
warmth — he conceives that cold drinks are always danger- 
ous, and generally fatal. f This was the opinion very generally 
of the surgeons in India. Mr. Annesley, however, gave cold 

* Communication from St. Petersburgh, July 20, 1831. 
Madras Report. 



89 

water with a slight impregnation of nitric acid. This was the 
general drink at the hospital under his care, and was found to 
relieve the most distressing symptom of the disease, the burn- 
ing sensation at the stomach.* From the experience of the Eu- 
ropean physicians, it would appear very fully settled, that cold 
drinks are not more prejudicial than warm, and when desired 
by the patient, should be freely given. According to Lefevre, 
iced lemonade has often been taken with advantage,! and even 
the lower orders of the Russian people drank their quass as 
usual, and with seeming benefit. The diluted nitric acid, he 
states, may be added with great benefit to the common drink. 
I^ifty drops of the diluted acid, added to a pint of water, sweet- 
ened to the taste, is a grateful beverage.^: Mr. Orton allowed 
usually only moderate quantities of a weak infusion of ginger, 
with the addition of a little sugar and milk.§ Dr. Dyrsen, of Riga, 
says, that when the thirst is great, warm or even hot drinks are 
the best, and are often retained and even desired by the patient. 
He directs infusions of the various mild aromatic herbs, or 
when these are unpleasant to the patient, of common black tea. 
But when the patient desires earnestly cold drinks, they maybe 
given in small portions at a time, without fear of any bad con- 
sequences. Fresh milk, moderately cool, he states, has been 
found very beneficial, and when the diarrhoea is considerable, a 
decoction of rice or pearl barley, thin tapioca, and the like, to 
which, when there is entire absence of pain or tenderness of the 
abdomen, a little red (Port) wine may be added. A cup of 
strong coffee he has found very readily to suspend the vomiting 
in this disease — he advises the patient, in case of the drinks be- 
ing rejected by the stomach, to be allowed to swallow small por- 
tions of ice somewhat rounded into the shape of a pill by being 
rolled between the fingers || — a practice also recommended by 
Broussais. 

The strongest testimony in favour of warm water, is that 
given by Dr. Sturm, a surgeon in the Polish army: writing from 
the encampment near Kamienka, he says, " The treatment which 
we now pursue is probably already known to you, as Dr. Hel- 
big has been ordered to publish an account of it in the newspa- 

* Annesley on the Diseases of India, p. 174. 

\ By Mr. Bell also, and some few of the practitioners of India, cold lemon- 
ade was allowed. Bell on Cholera, p. 108. See also Searle's second publica- 
tion on Cholera. 

% Lefevre on Cholera, p. 82 et seq. § Orton on Cholera, p. 309. 

|| Kurzgefaste anweisung die Orientalische Cholera, p. 37. 



90 

pers. It consists in nothing else than giving to the patient as 
much warm, nearly hot, water, as he is able to drink, in the 
quantity of a glassful every fifteen or thirty minutes. By the 
time he has taken fourteen glasses the cure is complete, with 
the exception of a slight diarrhoea, which it is not proper sud- 
denly to suspend. The effects of this plan of treatment are so 
quick and effectual, that in two hours, or often sooner, the pa- 
tient is well, particularly when it is commenced with sufficiently 
early."* 

Treatment of the Secondary Stage of Cholera. — After the more 
violent symptoms of the disease have been removed, that is, af- 
ter the vomiting and purging have been suspended, the regular 
action of the heart established, and the circulation and heat of 
the surface permanently restored, the attention of the physician 
must be directed to guard against or remedy local congestions, 
to prevent inordinate reaction, and to produce a healthy action of 
the bowels. Congestion is most liable to take place after the first 
stage or that of collapse is over, in the liver and lungs, and 
sometimes in the head also. For this, moderate blood-letting, 
local or general, according to circumstances, is the most cer- 
tain remedy. When febrile symptoms with determination to 
the brain present themselves, topical bleeding will be found very 
successfully to relieve it. The judicious employment of blis- 
ters, and of cold applications to the head, will also be of advan- 
tage. When the healthy condition of the bowels has not been 
produced by the remedies administered in the first stage, mo- 
derate doses of calomel, followed by castor oil or other mild 
purgatives, will be demanded. As soon as the discharges have 
become feculent, the patient may be considered out of danger, 
and the purgatives discontinued, but not until then. Tender- 
ness or fixed pain in the region of the stomach or any part of 
the abdomen, call for the application of leeches.f 

The great debility which necessarily continues for a short 
time after the symptoms of the first period of the disease have 
been removed, would appear to many to demand stimulants, 
powerful tonics, and a nourishing diet; but these are dangerous 
remedies. Simple debility is seldom dangerous in this or in 
any other malady: it is best removed by a light, unirritating, 
and very simple diet, in connexion with properly regulated ex- 
ercise. Change of air has been found to exert a remarkably be- 

* Beobachtungen uber die Assiatische Cholera, von Dr. Hille, page 92. 
t Bell on Cholera. — Annesley on the Diseases of India. 



91 

neficial effect during convalescency from Cholera, provided it 
can be obtained without much fatigue or exposure.* 

We need hardly say that much depends upon the careful at- 
tention of the patient during some time after recovery, to avoid 
all the exciting causes of the disease, and thus prevent a second 
and perhaps fatal attack of the disease. Strict cleanliness, tem- 
perance in the widest signification of the term, appropriate cloth- 
ing, equanimity of mind, regular exercise and repose, are the 
sole means to ensure a perfect restoration of health and its con- 
tinued enjoyment. 

Having reviewed, in succession, the various therapeutical 
agents which have been had recourse to for the cure of Chole- 
ra, and stated the indications which they have been intended to 
fulfil, we shall now exhibit an analysis of the symptoms of the 
disease, with reference to the treatment. We propose, in fact, 
to place before our readers the several circumstances under 
which the practitioner will be required to act with prompti- 
tude and effect. 

Whether we compare the epidemic with our own endemic 
cholera, in reference to the progress and phenomena of the two 
diseases, or compare each of the several stages of this epide- 
mic with some one stage of other familiar diseases, we, in these 
United States, need not look on it with wonderment, as pe-. 
culiarly new or anomalous. We have already had occasion, in 
the chapter in which the symptoms were described, to show 
that the difference between the epidemic and the endemic, or 
even sporadic Cholera, is rather in degree than in kind. If the 
group of symptoms in the latter be thought sufficient to indi- 
cate a rational treatment, we cannot well refuse to the collec- 
tion of symptoms in the former, a similar indication. Nothing 
short of rank empiricism should make us rely in either disease 
on any one remedy, to the exclusion of others, nor on the same 
routine or succession of remedies without regard to the stage 
of the disease, or the age, constitution, and prior habits of the 
patient. But we are told that the want of success in the treat- 
ment of the Epidemic Cholera, or Cholera Asphyxia, is dis- 
couraging, and that the differences of practice among medical 
men are sufficient to induce scepticism of the value of any at- 
tempt at cure. It is indeed deeply distressing to see sudden 
and numerous deaths from Cholera^ but to be able, by human 
power, to prevent a great number of these, considering the 

* Orton on Cholera. 



92 

class of people attacked, their situation, and habits, and their 
neglect of first symptoms, would imply, not so much a deficiency 
of skill and weak resources of art, as the possession of nearly 
miraculous power. As relates to the second objection, need 
we be surprised that the practice in the disease of India should 
be different from that in Russia, or that the course found useful 
in the cases of the European soldier and civil servants of the 
East India Company, should not be applicable to the miserable, 
filthy, drunken serfs of Russia, or scum of the people in the 
cities and towns of Great Britain and Ireland. 

In comparing the therapeutical agents which have been re- 
commended and used for the cure of Epidemic Cholera, with 
those which we either have recourse to or would promptly put 
in requisition in our own endemic form of the disease, we can 
discover no addition to our store — no discovery of any moment. 
We say nothing now of the many pretended specifics which 
have had their short-lived reputation in Epidemic Cholera, 
such as camphor, cajeput oil, flowers of bismuth, 8cc. or the 
nostrums vended with fraudulent intent by avaricious empi- 
rics. 

But while thus left free to adopt for ourselves a course of 
treatment for this disease, it does not follow that we should 
do so at random. The American physician has good data for 
a ratio medendi of Epidemic Cholera, obtained from his know- 
ledge of the endemic disease. He has also annually before his 
eyes a representative of the malady in question, in the Cholera 
Infantum, or endemic of our cities, between which and the Cho- 
lera Asphyxia, there is not only resemblance, but often strict 
identity. In both, there is for the most part a precursory stage, 
marked by diarrhcea and other symptoms of intestinal irrita- 
tion — in both, we have discharges of the same kind and variety, 
in the second stage, together with symptoms of collapse of the 
capillaries of the skin, which is cold and sodden, and also shrunk- 
en and altered features. In both, the first and violent stage of 
Cholera will often be followed by fever, and various degrees of 
complication, in phlegmasise of other organs. Commonly, indeed, 
the second, or strictly Choleric stage, rnns its course with more 
rapidity in the Epidemic Cholera than in the endemic variety 
attacking children; and yet we have seen instances of nearly as 
rapid a course, and violent a termination, of the latter as of the 
former malady. The Cholera fever is in general, more dis- 
tinctly marked and of longer duration in Cholera Infantum 
ian in Cholera Asphyxia, but even here there are no distinctly 



93 

contrasted features by which to show any specific difference 
between the two diseases. Strong as are the evidences of 
gastro-intestinal irritation, and clearly referrible as are the 
symptoms of Cholera Infantum to this source, dissections have 
not, any more than in the epidemic variety, with any uniformi- 
ty, added to the force of our convictions on this head. So that, 
even in the uncertainties of their pathology, there is a resem- 
blance between the two diseases. 

Akin to Cholera, if we have regard more especially to gas- 
tric distress, and violent spasm of the muscles of the abdo- 
men and limbs, is Bilious Colic, a common disease in the mid- 
dle and southern states. The chief causes of this malady 
are the same as those of Cholera, viz. irritating ingesta, and 
suppression of the cutaneous functions, by the sudden appli- 
cation of cold to a body overheated, and enfeebled by much 
exercise in, and exposure to the sun. It is also often the foun- 
dation, or first stage of bilious fever. To the parallel between 
the cold, eg*, on occasions, comatose stage of intermittent fever, 
and the collapse and asphyxia of Cholera, we have already ad- 
verted. The same order of parts is affected in both, viz. the 
abdominal viscera, the lungs, the heart, and the brain, by con- 
gestion. In both, death has taken place in this stage; in both, 
reaction may come on to the present relief of the patient; but 
with the effect of bringing on new and different symptoms, re- 
quiring for their removal remedies of a different nature from 
those administered in the first stage. 

On recapitulation, we find, that our common disease, the En- 
demic Cholera, both of adults and children, acknowledges com- 
munity of causes, and of pathological phenomena, with Epide- 
mic Cholera, and that between the latter and bilious colic, and 
the cold stage of intermittent fever, there is a close resem- 
blance. All these familiar endemics, in various sections of our 
country, have their seat and sustaining cause in the same or- 
gans, viz. — primarily, in the gastro-intestinal canal — secondarily 
and sympathetically, in the liver, spleen, and often brain, which 
are engorged. Impressions on the skin have, it is true, a very 
important bearing on these diseases — since, but for the conti- 
nued debility and deterioration of function of this surface, kept 
up by residence in a damp and unwholesome air, and want of 
suitable clothing and cleanliness, the digestive canal would not 
have acquired that susceptibility by which ingesta become ir- 
ritating, and act as exciting causes of the diseases referred to. 
Still it is not the less true, that the gastro-intestinal surface is 

M 



94 

the prime seat of irritation — whence this morbid state is radi- 
ated to other parts of the body. 

Attempts have been made to show, that Cholera Asphyxia, or 
Epidemic Cholera, has its chief seat in the ganglia of the great 
sympathetic, and the spinal nerves. Dissections barely give a 
colour to such a supposition, which, moreover, is not borne out 
by the phenomena of the disease. That the centre of the nervous 
system of nutritive life, should suffer in a disease in which are 
involved all the organs supplied by this system, is natural 
enough. But this is rather one of the effects, than a cause of 
the disease — just as turgescence of the brain, and delirium, are 
effects often of gastro-hepatic inflammation. The convulsive 
movements of the muscles of the abdomen and extremities, lead 
us to presume, of course, an active state of the spinal nerves, 
but by no means an inflammatory lesion of them, or of the 
spinal cord itself. There is reception of a strong irritation 
from sentient surfaces by this cord, and its subsequent trans- 
mission to the muscles; but this series of actions dqes not im- 
ply inflammation such as might be suspected where' there was 
fixed tetanic spasm. 

Treatment of the first or forming stage of Cholera. — If we 
examine, in succession, the several stages of Epidemic Cholera, 
we believe that the symptoms will be found sufficiently indica- 
tive of the order of parts affected, and will, in a measure, guide 
us to a rational treatment. In the first or forming stage, we 
meet with diarrhoea. Atony of the skin, and the use of unsuit- 
able ingestce, are causes adequate always to the production of 
this disorder — the greater the atony of the skin, the more rea- 
dily will diarrhoea be induced by the slightest deviation from 
the customary regimen. Sudden and powerful depressing 
causes, such as cold and moisture, or mental anxiety and fear, 
will induce this state of things, even without any change of 
diet. The colon is the part of the intestinal canal, on the irri- 
tation of which we know the symptoms of diarrhoea more par- 
ticularly to depend. The practical question then arises — how 
are we to manage this forming stage? how contrive that it shall 
not be followed by the invasion of Cholera in all its horrors and 
danger? Certainly not by specific remedies, or an uniform 
treatment. Regard must be had to the constitution of the in- 
dividual complaining, and to the extent of pain or tenderness 
of the abdomen, and sympathetic vascular irritation. At this 
time, says Dr. Kirk, " the skilful practitioner will give pills 
composed of aloes and calomel, or a pill composed of scam- 
mony, calomel, and aloes. The bowels, then, in general, act 



95 

briskly. Continue the course for three days — keep the patient 
warm in bed — give him mild and gentle nourishment — and 
after an immense quantity of horribly offensive dejections, the 
patient is completely recovered, and snatched from the jaws of 
the dreadful fate which awaited him. Some practitioners pre- 
scribe the mustard emetic in this state, small doses of calomel 
and ginger, and bleeding freely; but I prefer decidedly and on 
experience, the purgative system." In the cases of individuals 
whose bowels are habitually torpid — who have indulged in the 
use of irritating ingestse — or in whom there is an absence of 
much heat or pain of the abdomen, the purgative plan will, 
doubtless, answer well. But as our object here is to allay in- 
testinal irritation, we have but to recur to former and long- 
tested experience, which shows that one of the very best means 
for this purpose, especially where diarrhoea is present, is to 
keep quiet in a recumbent posture, restore the warmth of the 
skin by additional clothing, friction, and the warm bath, and to 
take warm drinks, either simple diluents, or those of a stimu- 
lating nature, according to the condition of the stomach, and 
the prior habits of the patient. It was often sufficient, in this 
forming or diarrhoeal stage, for the person to go to bed, get 
himself warm, and take a draught of hot herb tea. Perhaps a 
dose of castor oil, or of magnesia, may be premised. The great 
object in this stage, is to restore the lost balance of function — 
to bring back the skin to its natural action, and in so doing*, to 
restore the bowels to their healthy secretions.* Failing or ne- 
glecting to do this, the remote cause of disease still acting, and 
acquiring additional power by the irritation caused by exciting 
ones, the patient is thrown into the second or distinctly marked 
choleric stage of the disease. 

* In a case, the symptoms of which were evidently of choleric diarrhoea, and 
which came under the care of Dr. Bell, in the month of May last, he had the pa- 
tientbled, prescribed calomel and rhubarb pills, and afterwards a grain of opium, 
with some magnesia. — The patient was soon restored to health. In directing 
venesection, Dr. B. was not so much induced by the choleric form of the dis- 
ease, as by his knowledge and former attendance on this person, of hisprone- 
ness to enteritis. We have said that the symptoms were evidently of choleric 
diarrhoea. The patient went to bed, feeling as well as usual — he was awoke 
in the night with urgent desire to go to stool, which was often renewed, and 
barely allowed of his getting out of bed for the purpose — the discharges were 
profuse, resembling, as he expressed it, gruel, and at another time he compared 
them to rice water. They were very exhausting, and accompanied with some 
nausea and heat of the stomach. The tongue was white and loaded — pulse 
small, and rather frequent. He complained also of severe cramps in his legs. 



96 

Treatment of the second stage, or that of distinctly marked Cho* 
lera. — The transition, says Dr. Craigie, from the diarrhceal stage 
to that of collapse, though rapid, is never made per saltum, as 
it were, but in all cases, in however short a time, by gradual 
and successive changes. In most of the cases in which I had 
an opportunity of remarking this transition, the countenance 
became first slightly blanched, and the skin began to assume a 
colliquative humidity. When the pulse was felt at this period, 
it was not gone; but greatly weakened in force, and small in 
its size. The patient, at the same time, complained of a sense 
of sinking at the breast, with an uncomfortable sense of thrill- 
ing heat and unsteadiness, as if unable to support himself; and 
though there were instances in which the patient fell down at 
this period, from weakness, yet afterwards, when the stage of 
collapse was thoroughly established, this extreme enfeeblement 
of the voluntary muscles was not recognized. 

Bearing in mind the remark of Dr. Craigie, that by far the 
most powerful, both as predisposing and exciting causes, are 
to be found in the diet of the persons attacked; and remember- 
ing the habits of those who are the most ready victims to the 
disease, as well as its great frequency and mortality in coun- 
tries, the rural population of which has been compelled to use 
damaged or imperfectly matured grain, or vegetable produc- 
tions of an indigestible nature, we cannot doubt of the gastro- 
duodenal seat of Cholera. The first symptom — an uneasy 
constriction or cramp deeply seated in the epigastric region, 
speedily followed by profuse vomiting and purging of watery 
fluids, would seem to show the duodenum to be the part more 
immediately affected. Farther corroboration of this view is 
furnished in the effects of poisonous substances and putrescent 
animal matter taken into the stomach. After a time, their in- 
gestion is followed not only by vomiting, but by great prostration 
of strength, cold and clammy sweats, shrunken features, small 
and frequent pulse, and often violent spasms of the voluntary 
muscles. The treatment under the circumstances just mention- 
ed, which is generally deemed most serviceable, is to encourage 
the expulsion of the offending matters by a mild emetic, and 
free dilution, by draughts of warm water, or some other bland 
fluid. A similar practice has been adopted in Cholera, and, in 
many cases, on good grounds, especially when the attack is re- 
cent, and the discharges are either mixed with the food, or are 
white and inodorous. Inflammation cannot be presumed to 
exist at this time. The stomach had, up to the date of the at- 



97 

tack, exhibited often its customary craving for food, and was 
not oppressed by its reception — the tongue and skin, and ab- 
sence of thirst, did not betoken gastritis or gastro-enteritis; 
and hence we are left free to substitute one irritant, or medi- 
nal and controllable one, for another of a more poisonous 
kind, which is acting on the mucous expansion of the small in- 
testine, especially of the duodenum. 

Some practitioners prefer ipecacuanha, others sulphate of 
zinc, and some again, mustard, in order to produce full vomit- 
ing in Cholera. Mr. Hall, in his account of" Epidemic English 
Cholera," prevailing on the river Medway, tells us, that "having 
practically discovered the efficacy of exciting full vomiting by 
emetics of ipecacuanha, he employed this in future, in every 
case, without exception. Several of the cases were infants at 
the breast^ some were pregnant women, and one was a female 
above eighty years of age. In every case an ash-coloured, 
slimy, consistent fluid, of a peculiar smell, as well as sourish 
taste, was discharged by full and efficacious vomiting." 

"If," says Mr. Greenhow, (on Cholera) "the stage of col- 
lapse have not yet established itself, and if, with bilious diar- 
rhoea, the patient complains much of nausea and occasional 
retching, the matter rejected consisting principally of undigested 
food, we shall probably find a dose of ipecacuanha, with or 
without antimony, answer the purpose, or even copious draughts 
of warm water will suffice to wash out thoroughly the contents 
of the stomach." 

At this time, should the patient be of sanguineous habit, or 
complain of pain in the abdomen, head-ache, or vertigo, with 
accelerated pulse, we may have recourse advantageously to ve- 
nesection. 

A favourite, and, as it would seem, successful practice, in 
Russia and Poland, was to give a solution of common salt, so 
as to procure vomiting. After this, bleeding was often had re- 
course to, and with marked advantage. 

After the operation of these remedies, calomel, or calomel 
with opium, has been given with a view to restore the biliary 
and natural intestinal secretions. For such an object, calomel 
alone is best adapted, followed by castor oil, or rhubarb and 
magnesia. 

In cases in which the stage of collapse is impending, or has 
actually supervened, with violent spasms and excessive cold- 
ness of the surface, our remedial course must be prompt and 
energetic. Guided by what we know to be good and success- 



98 

ful practice in bilious colic, in which there is great pain of the 
abdomen, and cramp of the voluntary muscles, viz. — to bleed 
freely, give large doses of laudanum, and immersion in the 
warm bath, we should have some confidence in a similar course 
in the critical stage of collapse of Cholera. Here, however, 
we are required to be still more prodigal than in the former 
disease, of every variety of external stimulus — frictions with 
warm cloths, or with mustard flour and spirits of turpentine, 
dry heat by the introduction of hot air under the bed-clothes, 
by the application of heated bricks or irons, bags of hot sand, 
salt, or oats, flannels, &c. — sinapisms to the epigastrium — along 
the spine, and to the inside of the calves of the legs, and on the 
inside of the arms. The warm, or, rather, the hot bath, for to 
be of service, it ought to be upwards of 100° F. — is a remedy of 
undoubted power, and if found serviceable in India and Europe, 
cannot be without value among us. The warm bath has doubt- 
less disappointed many practitioners, owing to their not using 
it of a sufficiently elevated temperature, nor insisting on a long 
enough immersion of the patient in -it. "I know a gentleman," 
says Mr. Greenhow, " who suffered from Cholera in Archan- 
gel, during the last summer, and who was restored from a state 
of complete asphyxia by being kept in a warm bath of high 
'temperature, for an hour and a half." In reply to the objec- 
tions made against the remedy, from the circumstance of the 
danger of the patient's using any voluntary exertion, and of the 
necessity of his strictly preserving the horizontal position dur- 
ing arrested circulation, this author very properly remarks, — 
" The patient might merely be placed in, and removed from it, 
with such quickness and so little disturbance, as to obviate the 
objections that have been made to it." 

Experience teaches that few means are better calculated to 
rouse the sensibility and excite the action of the cutaneous ca- 
pillaries, than the vapour bath. Accordingly, it has been used 
largely in different parts of Europe in the asphyxia, or col- 
lapsed stage of Choleraj and, as we learn from Dr. Ucelli, of 
the Crimea, and others, with marked benefit. Some have ob- 
jected to the application of moist vapour to the skin, already 
sodden and wet with cold sweat — and allege that it is of the 
utmost importance to keep the skin dry, by constant rubbing 
with dry and warm cloths. — The objection is hypothetical, and 
based upon erroneous data.— A leading object is to rouse the 
capillaries of the skin to action; and heat combined with water 
in the form of vapour, will be found one of the most efficacious 
means of accomplishing this end. It has also been said that 



99 

the use of the vapour bath is apt to cause undue fulness and 
turgescence of the vessels of the head, and determination to the 
brain. This effect may be obviated, however, and is at the 
moment comparatively of minor importance to the collapse 
and asphyxia from which it is so desirable to rouse the patient. 
When we recommend the vapour bath, we of course mean 
our remarks to apply to that variety in which the head is 
external to the bath, and the patient does not breathe the va- 
pour. 

Dr. Kirk has applied the actual cautery in the stage of col- 
lapse in three different cases — they were all fatal ones.— -The 
cautery he uses is a tube of porcelain, of a foot long, and an 
inch and a half diameter. It is inclosed in a copper tube, to 
which it is luted at the upper and under ends. A rod of an 
inch and a quarter diameter is made, of the length of this tube, 
and one half inch longer exactly. The rod has a little wooden 
handle at top. It is made red hot, and introduced into the 
tube in another room, and delivered to the Surgeon in that 
state, who, by pushing it down its extreme length, and applying 
it to the skin, can apply the actual cautery, without the patient 
knowing that a red hot iron has been used. 

The best place to apply the cautery seems to be the lower 
part of the back of the head where it joins the spine, and along 
the spine itself. Dr. Barry says that Dr Lange, at Cronstadt, 
by the cautery, cured 12 cases out of 14. This is rather too 
strong a claim upon our belief. 

" The next effectual and most efficacious mode of applying 
a violent irritant, is by placing on the skin a cloth newly wrung 
out of boiling water. This mode I am in the habit," says Dr. 
Kirk, "of regularly practising, and often with benefit. The 
blister is raised instantaneously, and in the pains of the hypo- 
gastric regions, so common in this disease, it in general gives 
relief in a few minutes. The next speediest mode is the infu- 
sion of cantharides in strongest acetic acid, which will raise an 
effectual blister on the scalp, or other part of the skin, in a few 
minutes." 

Among the internal means of rousing the patient in the stage 
of collapse, and bringing on reaction, are the administration 
of a mustard emetic, followed by laudanum and ether, each 
twenty-five drops, in an ounce and a half of strong peppermint 
water — or pills of opium in grain doses — warm brandy and wa- 
ter, or hot water itself. Of the great efficacy of this last simple 
remedy, in kindred states of the animal economy, We can speak 
with great confidence, We are surprised not to have seen 



100 

mention made of the camphorated draught with nitrous acid 
and opium, as recommended so strongly by Mr. Hope, and 
since largely used by other practitioners in dysentery. It is a 
remedy entitled to confidence and early use, after the exhibition 
of an emetic, or action on the bowels by calomel. 

In reference to the free use of brandy and such like diffu- 
sible stimuli, we cannot do better than give the opinions of 
Dr. Kirk, to which we entirely subscribe: — 

" Is brandy, then, a remedy in any stage of this disease? In 
the report, I have permitted its use in small quantities, not 
venturing to make an innovation on the established practice by 
avoiding it altogether; but it is now my duty to say decidedly, 
that the cup of brandy you perpetually see at the head of the 
Cholera patient, cannot be given to him innocuously. His bow- 
els are in general in a state of positive high action and inflam- 
mation: so are his brain and spinal marrow, and so are even 
the vascular systems of the greater nerves. What do we gain 
by brandy? We obtain a temporary diffused excitement from 
its stimulant powers, and a kind of soothing of the sensations 
from its narcotic influence; and can these effects produce any 
change in that morbid condition of the system, which, we have 
seen, is the cause of Cholera? I will be told that brandy, by the 
mouth and by enemata, have often and evidently done good. — 
Let, then, this be its restricted use. Never give it, either in 
the one mode or the other, but in those extreme cases of dis- 
ease where even the temporary fillip to nature, which it can 
give, may be courted; and though it is to come into contact 
with and irritate diseased tissues, still perhaps, in these extreme 
circumstances, its use may be indicated. But in the premoni- 
tory stages, while action, sometimes high action, still exists,' — 
and when we know many vital parts are highly irritated, and 
that our business is to subdue that action, — I never see the 
glass of brandy at the patient's head without a shudder. It is 
a fact that intelligent practitioners are every day becoming 
more and more cautious of the use of this stimulant. I feel 
that I have ventured far in this wholesale condemnation of it; 
but I confidently anticipate the decision, in my favour, of those 
who are to come after me, inasmuch as my views are certainly 
founded in the ascertained pathology of the disease. When I 
think a cordial strongly indicated, I am in the habit of prefer- 
ring the pure wines, the irritation to the inflamed tissues, from 
their use, being less to be dreaded than the sharp and naked 
points of alcohol." 

Enemata of various compositions have been much used in 



101 

the different stages of Cholera.—- In the stage of collapse, large 
injections of warm water have been much used in the north of 
England, and with a very encouraging result. Mr. Lizars di- 
rects the water to be as hot as the hand can bear — in quantity 
three or four pints, with a teaspoonful of laudanum. In cases 
where it was retained in the intestines for the period of an 
hour, it has come off quite cold. If reaction does not take 
place, the injection should be renewed in less time than an 
hour, — the former one having been sucked off by the enema 
pump. The chief agent here is heat applied to a large intes- 
tinal surface, and the plain hot water thus repeated, has been 
found more efficacious in relieving the spasms and collapse 
than the laudanum. By keeping the fingers on the anus for 
five minutes, the sphincter would generally resume its tone, 
and the injection will be retained for hours together: but should 
an occasional cure of relaxed sphincter occur, the plan of Dr. 
Clanny, of Sunderland, will answer very well; it is to merely 
plug the rectum with a thick greased wax candle. 

The more stimulating injections of spirits of turpentine, 
camphor, Sec. are retained but a short time — they cause much 
local irritation, and at times bloody discharges, without favour- 
ing general reaction — and on good grounds are objected to. 

Swayed by an hypothesis that there is a spasmodic stricture 
of some of the important organs, as of the ventricles of the 
heart, the intestines, and of the duct of the gall-bladder, and 
of the urinary bladder, as well as of the secreting organs; 
some of the British practitioners have prescribed tobacco ene- 
mata. It is used in infusion, made with half a drachm to a 
drachm of the tobacco, in a pint of water. Mr. Baird, of New- 
castle (England), the originator, we believe, of this practice, 
tells us, that if his pathological " opinion had been at variance 
with the fact, the powerful remedy he had adopted, must of ne- 
cessity have hurled the patient into the -grave;" but the cases 
which Dr. Kirk appends to his essay on Cholera, would seem 
to entitle it to some confidence — yet we cannot forget that the 
symptoms produced by an over dose of tobacco on a healthy 
man, are nearly the same as those met with in the collapse of 
Cholera. That we may not, however, prejudge the doctrine 
and practice, we shall give the details of a case in which it was 
used with apparent advantage.* Dr. Kirk says, I have seen ten 
cases of the exhibition of tobacco myself, and though in two 
life was not saved, yet in all distinct reaction took place; and 
all the symptoms were improved. 

* See Appendix. 
N 



102 

Among* the means of alleviating and arresting the violence 
of the spasms, and enabling us at least to gain time for the ad- 
ministration of other remedies, the application of the tourni- 
quet to one of the limbs merits a trial. We have heard the 
late Dr. B. R. Reese, of this city, speak in high terms of the 
beneficial effects of the tourniquet, in cases of the Cholera 
coming under his charge in Canton, China. 

It would seem from the best evidence furnished us in the 
treatment of Cholera, that, whilst we may be justifiably prodi- 
gal of external remedies to rouse the collapsed capillaries to 
action, and the transmission of blood, we cannot by any means 
exercise the same freedom in the employment of internal sti- 
muli. In the collapse of Cholera, we have, not a case simply of 
debility, but of debility and congestion — it is desirable to rouse, 
it is true, and to equalize the action of the system, and to re- 
lieve the oppressed viscera. But we well know that this is not 
to be accomplished readily or safely, by much internal stimula- 
tion. In apoplexy, and even in asphyxia, we are not free to use 
these without limitation and wise discretion. In that stage of 
disease which bears the closest analogy to the collapse of Cho- 
lera — we mean the chill of intermittent fever-— the prodigal 
use of internal stimuli would seem to be called for by all the 
symptoms in the case. Yet, aware of the subsequent reac- 
tion, we well know that no small reserve is requisite, in the 
administration of such remedies. During the chill, they have 
very little effect — they are, as it were, in almost insensible cavi- 
ties, in the stomach and bowels; but the hot stage supervening, 
and the susceptibility of the parts restored, they powerfully sti- 
mulate, and even irritate — increasing the fever, causing deli- 
rium, and phlogosed stomach, and leaving a more imperfect re- 
mission than would have followed, had their use been entirely- 
withheld. But not only are we wary of using internal stimuli 
in the cold stage of intermittent fever — we even on occasions 
have recourse to sanguineous depletion at this time.* We have 

* The following case is so confirmatory of the above views, that we are 
persuaded it will interest our readers — we give it as related by one of the au- 
thors of this Essay, Dr. Bell, in the North American Medical and Surgical 
Journal, Vol. VIII. The patient had had an attack of bilious fever, for which 
he had been repeatedly bled from the arm, and cupped over the abdomen. 
Convalescence seemed about to be established. " The patient gained very 
little strength, although he was allowed light animal broth and farinaceous food. 
Visited in the afternoon of September 17th of last year [1828], I found him in 
a state of great apathy, with an inclination to dose. The pulse was not ma- 
terially altered, nor was there any other new symptom. A blister was di- 



103 

ourselvesjdone so, and we have reason to believe, with good ef- 
fect. This practice has been adopted, and is strongly recom- 
mended by Annesley. — (See Appendix.) 

The remarks of this writer on the stage of reaction in the true 
Cholera fever are exceedingly important, and are corroborated 
by nearly every physician who has witnessed the disease. It 
would be well if we could almost forget the existence of the 
previous stage of prostration and collapse, if it so far occupy 
our minds as to induce a dominant idea and fear of debility, 
and lead to the exhibition of stimuli in this reaction or third 
stage. It is in the complications of symptoms, by phlegma- 
sia of the gastric intestinal surface and oppression of the 
brain at this period, that the injurious effects of the unrestricted 
use of brandy and laudanum in the early stages, including the 
period of collapse, become evident. It is at this juncture that 
we must draw upon the resources of rational pathology, and be 
guided in our practice by the symptoms of lesion and inflam- 

rected to the back of the neck, and a laxative of rhubarb and magnesia at 
bed-time. At 11 o'clock, P. M., I was sent for in great haste, and on my ar- 
rival found the patient in a state of complete coma, utterly insensible to all 
objects of sight, sound, and touch; hfs limbs, at first extended, remained in 
whatever position they were placed ; the pulse was barely perceptible, and 
the breathing very slow. It was impossible to make him swallow any thing, 
or to elicit from him the slightest evidence of consciousness. On applying 
my hand to the epigastrium, I could feel the abdominal aorta beat with con- 
siderable force ; so also did the carotids. The contractions of the heart were 
frequent, and laborious. The blister had been put on, but no medicine taken. 
Sixty leeches were now applied over the epigastrium, and sinapisms to the 
extremities. After the leeches had begun to fill, the pulse lost somewhat of 
its extreme tenuity, and by the time they were detached, it had regained its 
natural volume, was soft and easily compressible. The patient at this time 
began to move his eyes and the muscles of his mouth and face ; he turned a 
little towards one side, yawned and stretched himself. The extremities were 
still cold and unaffected by the sinapisms. Before all the leeches were re- 
moved, the skin became moist in places ; and finally a sweat covered the face, 
trunk, and limbs, with the exception of the hands and feet. Enemata of tepid 
water were administered at different times throughout the night. In the 
morning, though languid, he was partially sitting up in bed, by leaning on 
his elbow, helping himself to some light nutriment. In the afternoon of this 
day he experienced some rigours, which disappeared in the evening in mois- 
ture on the skin. 

" On the evening of the following day, 19th, by eight o'clock, he was in 
nearly the same state as on the 17th, being completely comatose. Cups in 
large numbers were now applied to the temples, and over the abdomen, so as 
to detract about ten ounces of blood. The effect was most salutary, and the 
recovery even more prompt than from the first attack, Enemata of cold 
water were given on the present occasion." 



104 

malion of the organs. Patience and firmness are now virtues 
to be put in requisition — the former to prevent undue haste in 
forcing up the system to an imaginary standard of strength by 
stimuli, the latter to induce perseverance in judicious local deple- 
tion and cooling practice, to moderate the excitement of parti- 
cular organs, and prevent disorganizing inflammation in them — ■ 
the stomach, intestines, or brain. 

Children, we are told, recover sooner than adults from the 
cataleptic or collapsed state. The first mark of rallying in 
them, was a slight injection of the conjunctiva, with marks of 
general restlessness and tossing of the head. After these, fol- 
low often all the symptoms of cerebro — meningeal, or hydroce- 
phalic inflammation, which, unless rapidly controlled, cut off 
the patient. In one case of this kind, Mr. Fife, of Newcastle, 
had leeches applied to the head twelve times. 

In the Appendix, we have subjoined a sketch of the practice, 
in Cholera, of some of the most eminent medical men of New- 
castle. When compared with that of Annesley, and others in 
India, and of some of the chief physicians on the continent of 
Europe, the reader will discover that, except in the article of 
calomel, there is not such a discrepancy in the employment of 
remedial means generally, where the disease has prevailed, 
as many, from superficial observation and reading, have ima- 
gined. 

In the " Observations on the Cholera of Paris," by two in- 
telligent young physicians of this city, Drs. Pennock and Ger- 
hard, we are pleased to find a general confirmation of the views 
expressed in the preceding pages, respecting the pathology 
and treatment of the disease. These writers lay great and 
deserved stress on the danger from inflammation after re- 
action. For a summary of the treatment recommended by 
Drs. Pennock and Gerhard, our readers are referred to the 
Appendix. 

We have not mentioned the inhalation of oxygen gas, nor the 
use of galvanism, among the remedial agents in Cholera, be- 
cause the few trials made of them, have not been so encou- 
raging as to attempt their repetition, even could this be done 
with less difficulty than necessarily obstructs their employment. 



APPENDIX. 

(A.) — Referred to page 46. 
EARLY NOTICES OF EPIDEMIC CHOLERA. 

(From the Report of the Madras Medical Board.) 

[Noticed by Bontius in 1629.] The Dutch Physician, Bontius, who wrot* 
in the year 1629, at Batavia, thus describes Cholera Morbus. " Besides the 
diseases above treated of as endemic in this country, the Cholera Morbus 
is extremely frequent; in the Cholera, hot bilious matter, irritating the sto- 
mach and intestines, is incessantly, and copiously discharged by the mouth 
and anus. It is a disorder of the most acute kind, and therefore requires im- 
mediate application. The principal cause of it, next to a hot and moist dispo- 
sition of the air, is an intemperate indulgence of eating fruits ; which, as they 
are generally green, and obnoxious to putrefaction, irritate and oppress the 
stomach by their superfluous humidity, and produce an OBruginous bile. The 
Cholera might, with some degree of reason, be reckoned a salutary excretion ; 
since such humours are discharged in it, as, if retained, would prove prejudi- 
cial. However, as by such excessive purgations the animal spirits are ex- 
hausted, and the heart, the fountain of heat and life, is overwhelmed with pu- 
trid effluvia, those who are seized with this disorder generally die, and that so 
quickly, as in the space of four-and-twenty hours at most. 

Such, among others, was the fate of Cornelius Van Royen, steward of the 
Hospital of the sick, who being in perfect health, at six in the evening, was 
suddenly seized with the Cholera, and expired in terrible agony and convul- 
sions before twelve o'clock at night; the violence and rapidity of the disorder 
surmounting the force of every remedy. But if the patient should survive 
the period abovementioned, there is great hope of performing a cure. 

This disease is attended with such a weak pulse, difficult respiration, and 
coldness of the extreme parts ; to which are joined great internal heat, insa- 
tiable thirst, perpetual watching, and restless and incessant tossing of the 
body. If, together with these symptoms, a cold and fetid sioeat should break 
forth, it is certain that death is at hand." 

In treating of the " Spasm," this author gives the following account. <: The 
disorder of the Spasm, almost unknown with us in Holland, is so common in the 
Indies, that it may be reckoned among the popular and endemic diseases of 
the country. The attack of it is sometimes so sudden, that people become in 
an instant as rigid as statues; while the muscles, either of the anterior or pos- 
terior part of the body, are involuntarily and violently contracted. A terri- 
ble disorder ! which, without any primary defect of the vital or natural func- 
tions, quickly precipitates the wretched sufferer in excruciating torments to 
the grave; totally deprived of the capacity of swallowing either food or drink. 
There are, likewise, other partial Spasms of the limbs ; but these being more 
gentle and temporary, I shall not treat of them. 

People affected with this disease look horribly into the face of the by- 
standers (truculente admodum astantes intuentur) especially, as often hap- 
pens, when the cynic spasm comes on, and both the cheeks are drawn in 
convulsion towards the ears ; a red and green colour is reflected from the eyes 
and face; (ruber et viridis color ex oculis et facie oritur), the teeth gnash; 
and instead of the human voice, a rude sound issues forth of the throat, as if 
heard from a subterraneous vault ; so that to those unacquainted with ths* dis- 
order, the person appears to be daernoniac." 



106 

In speaking of Cholera, Bontius no where mentions the colour of the mat- 
ters evacuated. He talks indeed of seruginous bile: but that would appear, 
from the context, to refer to its assumed acrimonious quality, rather than to 
any sensible property ; and we shall presently see that practitioners of much 
later times dwell greatly on the supposed bilious and irritative nature of the 
evacuations, when it is pretty evident, that they were merely speaking hy- 
pothetically. His descriptions indeed are not at all full: for, though he does 
not mention spasm as a symptom of Cholera Morbus, he states that Corne- 
lius Van Royen expired in convulsions, within six hours from an attack of it. 
Still, in his description of Cholera, where " the heart is overwhelmed," where 
" those who are seized with the disease generally die," and that within 
twenty-four hours at most ; and in his enumeration of symptoms as marked in 
italics, every one, familiar with the epidemic Cholera as it has prevailed in 
this country, will probably admit, that he has truly pourtrayed that disease, 
and no other. 

Although Bontius has treated of " the Spasm," and of " the Cholera Mor- 
bus," under separate chapters, it is highly probable that these disorders were 
one and the same. 

It would seem that he has considered the tonic spasm as idiopathic, and the 
clonic spasm as symptomatic, yet it is evident by the expression, " there are 
likewise other partial spasms of the limbs," that both these forms of spasm 
existed in the same patient, a fact which is amply confirmed by innumerable 
observations in the present epidemic. . If it be objected that he does not men- 
tion the usual symptoms of Cholera as occurring in " the Spasm,", it may be 
answered, that neither does he mention the state of the skin, of the pulse, nor 
of respiration, which functions it is impossible to suppose remained unaffected 
in such a commotion of the system. 

The edition of Bontius, which has been quoted from, is an English transla- 
tion, published in London, 1769; but, from the passages in the original, as in- 
serted in parenthesis, it is evident that the translation is not quite correct. 
The expressions, especially, of the eyes and face " reflecting'" a red and green 
colour can only be intelligible by supposing, that the former was suffused with 
blood, and the latter changed to that ghastly and cadaverous hue, so familiar 
to us all in the collapse stage of Cholera. 

[By Dr. Paisley in 1774.] The next notice, in point of time, which we find 
of Cholera, is in the copy of a letter written by Dr. Paisley at Madras, dated 
l'2th Feb. 1774, as given by Curtis, in his publication on the diseases of India. 
Dr. Paisley says, " I am favoured with yours, and am very happy to hear you 
have caused the army to change its ground ; for there can be no doubt, from 
the circumstances you have mentioned, that their situation contributes to the 
frequency and violence of the attacks of this dangerous disease, which is, as 
you have observed, a true Cholera Morbus, the same they had at Trincomalee. 
It is often epidemic among the Blacks, (natives) whom it destroys quickly, as 
their relaxed habits cannot support the effects of sudden evacuations, nor the 
more powerful operation of diseased bile. 

The first campaign made in this country, the same disease was horridly fa- 
tal to the Blacks; and fifty Europeans of the line were seized with it. I have 
met with many single cases since, and many of them fatal or dangerous, of 
different kinds, arising from putrid bile being disturbed by accidental causes, or 
by emetics or purgatives exhibited before it had been blunted or corrected." 

Dr. Paisley does not give any particular description of the disease: and 
though he dwells much on the putridity and acrimony of the bile, he does 
not allude to the colour or appearance of the evacuations. He observes that 
" when it (the Cholera) is epidemic here, it is totally a disease of highly pu- 
trid bile, which operates on the system as poison, and brings on sudden pros- 
tration of strength, and spasms over the whole surface of the body." In re- 
laxed habits, when the pulse sinks suddenly, and brings on immediate dan- 
ger, the same method must be pursued, but with more caution." The letter 
is quoted by Curtis as referring to the Cholera Morbus, or Mort de Chien: 
and these extracts will probably be deemed sufficient evidence of the correct- 
ness of the reference. 



107 

It is highly important to remark, that Dr. Paisley here speaks of the dis- 
ease as being "often epidemic;" that it prevailed in that form in the " first 
campaign," and affected both Europeans and natives. The particular periods 
here alluded to are not known, but we have seen, by the extract from the 
records of the Medical Board, that Cholera raged as an epidemic, in 1769, 
or 70. 

[By Sonnerat from 1774 to 1781.] Sonnerat, whose travels in India em- 
brace the period between 1774 and 1781, speaks of a disease on the Coro- 
mandel Coast, in all respects resembling Cholera, and he notices it as "an 
epidemical disorder which reigns.'''' His account of it is this. 

" There is also another epidemical disorder, which reigns, and in twenty- 
four hours, or sometimes less, carries off those who are attacked. It never 
appears but in cold weather." 

" Debauchees, and those who have indigestions, are attacked with a loose- 
ness, or rather with an involuntary flux of the excrementary matter become 
liquid, but without any mixture of blood. They have no remedy from this 
current of the bowels,* which they call a sharp flux, but leave the cure to 
the care of nature." 

" The flux of this kind which reigned some years ago, spread itself in all 
parts, making great ravages: above sixty thousand people, from Cherigam to 
Pondicherry, perished. Many causes produced it. Some were attacked for 
having passed the night and slept in the open air j others for having eat cold 
rice with curds; but the greater part for having eat after they had bathed 
and washed in cold water, which caused an indigestion, an universal spasm of 
the nervous kind, followed by violent pains and death, if the patient was not 
speedily relieved. This epidemical disorder happened during the northerly 
winds in December, January, and February; when they ceased, the malady 
disappeared. The symptoms of this disorder were a watery flux, accompa- 
nied with vomiting and extreme faintness, a burning thirst, an oppression of 
the breast, and a suppression of urine. Sometimes the deceased felt violent 
cholicky pains; often lost his speech and recollection, or became deaf, the 
pulse was small and concentered, and the only specific which Choisel, a for- 
eign missionary, found, was treacle and Drogue amere. The Indian physi- 
cians could not save a single person." 

" There is great reason to imagine that the perspiration being stopped, and 
reflowing into the mass of blood, by finding its way to the stomach and bow- 
els, occasioned the vomiting, which terminated by this flux." 

" That which followed, two years after, was the most dreadful. It did not 
proceed from the same cause as the first, as it began in July and August: it 
first showed itself by a watery flux, which came in an instant, and sometimes 
cut the deceased off, in less than four-and-twenty hours. Those who were 
attacked had thirty evacuations in five or six hours; which reduced them to 
such a state of weakness that they could neither speak or move. They were , 
often without pulse; the hands and ears were cold; the face lengthened ; the 
sinking of the cavity of the socket of the eye was the sign of death ; they felt 
neither pains in the stomach, cholics, nor gripings. The greatest pain was a 
burning thirst. Some brought forth worms by stool; others by vomiting. 
This cruel pestilence affected all the castes in general, but particularly those 
who eat meat, as the Parais. The native physicians succeeded no better in 
their treatment of this disorder, which was again renewed during the north 
winds." 

It is by no means easy to determine the precise dates of the epidemic visi- 
tations of Cholera alluded to in these extracts, as prevailing, in the first in- 
stance, " some years ago" and in the second, " txoo years after." It is, how- 
ever, reasonable to suppose, that a disease, which " spread itself in all parts," 
and carried off " above 60,000 people from Cherigam to Pondicherry," would 
not have been passed over without some special notice by Dr. Paisley, in his 
letter dated 1774, already quoted, had it occurred prior to that date. The 
presumption seems to be, that Mons. Sonnerat described invasions of Epide- 

* Probably " cours de ventre," in the original. The edition here quoted is 
a translation by Francis Nagnus, Calcutta, printed 1733. 



108 

mic Cholera which took place subsequently to the year 1774. That they 
were certainly considerably prior to that epidemic which is stated in the re- 
cords of the medical board to have prevailed " over the whole coast in 1783/ 
is evident, from the date of the work : and consequently, when viewed in re- 
ference to other authorities, it is obvious, that Cholera maintained its influ- 
ence, ivith little apparent interruption, from a very remote period, down to 
a date comparatively modern. Sonnerat notices the term " mort de chien," 
as being used in India, but applies it to " indigestions," which " are very fre- 
quent," and from which " many have died suddenly." 

[Cholera observed at Mauritius in 1775, and in 1819.] It appears from the 
report of a committee of British medical officers at the Mauritius, which was 
assembled in the month of November, 1819, under the authority of the 
government, in order to examine into the nature of the epidemic disease 
which then prevailed at that Island, that the Epidemic Cholera was not un- 
known there. The following is an extract from the report. " The commit- 
tee request to say, that they have not, either in this island or elsewhere, met 
with a disease possessing the characters of that which now prevails: but 
that, from the reports of several individuals, some of whom belong to the 
medical profession, it does appear, that a disease, most strongly resembling 
in its symptoms, progress, and termination, that now under consideration, did 
for some time prevail in this colony in the year 1775." 

The symptoms which are detailed by the committee, as characterising the 
epidemic of 1819, sufficiently indicate the identity of that disease, with the 
form of Cholera, which prevailed at the same period, and still continues, on 
the continent of India. " The symptoms, in the two cases alluded to, per- 
fectly corresponded with those of the numerous instances of the disease, 
which have since occurred. Those more particularly characteristic of the 
disease are sudden and excessive prostration of strength, with sinking of the 
pulse; extreme coldness of the surface of the body, which is covered with 
cold viscid perspiration; and a distressing uneasy sensation in the abdomen, 
the progress of which has generally carried off the patient in the space of a 
few hours." 

Dr. Burke, the chief medical officer in the island, makes the following ob- 
servation in his letter transmitting the report of the committee. " A similar 
disease prevailed in this island in 1775, after a long dry season, fyc. the symp 
torns, fatal and sudden effects, and duration, of the disease, would seem to be 
exactly the same. A hurricane put a stop to its ravages, which continued for 
probably two months, and caused a great mortality, particularly among the 
Blacks and people of colour." 

But it is necessary to state, that a committee of French medical gentle- 
men, who were assembled under similar circumstances with the British 
Committee, make no mention of the epidemic visitation of 1775. Assuming, 
however, the circumstance to be true, it is highly worthy of remark, that 
while, as we have shown in the preceding pages, the Indian continent suf- 
fered under Cholera, about that period, viz. 1775, the disease had then also 
extended to that remote island. 

[At Ganjam, in 1781.] Cholera appears to have manifested itself pretty 
extensively as an epidemic in 1781; its appearance on this occasion is thus 
noticed in the report on Cholera by Mr. Jameson, secretary to the Calcutta 
Medical Board. " A Division of Bengal troops, consisting of about 5,000 
men, was proceeding, under the command of Colonel Pearse of the Artillery, 
in the spring of 1781, to join Sir Eyre Coote's army on the coast. It would 
appear, that a disease resembling Cholera had been prevalent in that part of 
the country, (the Northern Circars,), some time before their arrival; and 
that they got it at Ganjam on the 22d March. It assailed them with almost 
inconceivable fury. Men, previously in perfect health, dropt down by dozens ; 
and -those even less severely affected were generally dead or past recovery 
within less than an hour. The spasms of the extremities and trunk were 
dreadful; and distressing vomiting and purging were present in all. Besides 
those who died, above five hundred were admitted into hospital on that day. 
On the two following days, the disease continued unabated, and more than 



109 

one half of the army was now ill." In a note it is added, " The occurrence of 
the disease on this occasion is noticed in a letter dated 27th April, 1781, from 
the supreme government to the court of directors; and the destruction which 
it caused in this detachment mentioned in terms of becoming regret." 

After adverting to its progress in the Circars, the letter thus proceeds: 
" The disease to which we allude, has not been confined to the country near 
Ganjam. It afterwards found its way to this place (Calcutta); and after 
chiefly affecting the native inhabitants, so as to occasion a great mortality 
during the period of a fortnight, it is now generally abated, and pursuing its 
course to the northward." It would have been interesting to have traced 
this disease, as it seemed to have put on the epidemical form, but every at- 
tempt to discover its further progress has proved fruitless. 

[Noticed by Curtis, in 1782.] From this period, up to the year 1787, and 
perhaps even to 1790, the Cholera would appear to have existed epidemically, 
in various parts of India. Curtis states, that the fleet, in which he served, 
joined Sir Edward Hughes's squadron at Madras, in the beginning of 1782; 
in May of that year, his ship, the Seahorse, arrived at Trincomalee, and he 
says, " The mort de chien, or cramp, I was also informed by the attending 
surgeon, had been very frequent and fatal among the seamen, both at the 
hospital and in some of the ships, particularly in the Hero and Superb." 
The Seahorse had no case of the disease till the 21st of June, when between 
that day and the 25th they had eight cases. 

" In every one of the eight cases the symptoms were so much alike, both 
in order and in degree, that a description of any one would answer almost 
equally well for every other. Any difference that took place was in the sud- 
denness of the attack, or the rapidity with which the symptoms succeeded 
each other. In all of them the disease began with a watery purging, at- 
tended with some tenesmus, but with little or no griping. This always came 
on some time in the night, or early towards morning, and continued some 
hours, before any spasms were felt; and slight affections of this kind being 
very common in the country, the patients seldom mentioned them till they 
began to be more severe, and extended to the legs or thighs. This -purging 
soon brought on great weakness, coldness of the extremities, and a remarka- 
ble paleness, sinking and lividity of the whole countenance. Some at this pe- 
riod had some nausea, and retching to vomit, but brought up nothing bilious. 
In a short time the spasms began to affect the muscles of the thighs, abdomen, 
and thorax, and lastly they passed to those of the arms, hands and fingers ; but 
I never saw, then or afterwards, those of the neck, face, or back, at all af- 
fected. The rapidity with which these spasms succeed the first attack, and 
their severity, especially as affecting the muscles of the thorax and abdo- 
men, denoted in general the degree of danger in the case. The affection is 
not, as in tetanus, confined to a single muscle, or to a certain class of mus- 
cles OHly. Neither does it, as in the spasmus clonicus, move and agitate the 
members. It is a fixed cramp in the belly of the muscles, which is gathered 
up into a hard knot, with excruciating pain. In a minute or two this relax- 
es, is again renewed, or the affection passes to others, leaving the miserable 
sufferer hardly an interval of ease: and, lastly, it passes from one set to an- 
other; from those of the inferior extremity to those on the upper parts, leav- 
ing the former free. The patients complain much of the pain of these 
cramps; think they obtain some relief from friction of the parts, and cry to 
their companions to rub them hard. As the disease proceeded, the counte- 
nance became more and more pale, wan, and dejected; the eyes became sunk, 
hollow, and surrounded with a livid circle. The pulse became more feeble, 
and sometimes sank so much as not to be felt at the wrist, in two or three 
hours after the spasms came on. But so long as it could be felt, it was but 
little altered in frequency. If the spasms happened to intermit, it would 
sometimes rise a little, and the countenance assume a better look. The 
tongue was generally white, and more or less furred towards the root; the 
patients had all great thirst, or rather a strong desire for cold drinks; but 
there was no head-ache or affection of the sensorium commune throughout. ," 

" The coldness of the extremities, which was perceptible from the very 

o 



110 

first, continued to increase, and spread over the whole body, but with no 
moisture in the skin till the severity of the pain and spasms forced out a 
clammy sweat, which soon became profuse. The hands now began to put on 
a striking and peculiar appearance. The nails of the fingers became livid, 
and bent inicards : the skin of the palms became ichitc, bleached, and wrinkled 
up into folds, as if long soaked in cold water ; the effect, no doubt, of the 
profuse cold sweat, which is one of the most pernicious and fatal symptoms 
of the disease, both from the effect it has in such a climate, of exhausting 
the strength, and in abstracting heat from the system. In some of the pre- 
sent cases, and in many others after this, we had recoveries from the severest 
degrees of spasmodic affection; even where the pulse had been for hours 
completely lost at the wrist, and the body perfectly cold ; but never of any 
who had these profuse cold clammy sweats, and where the hands had put on 
this appearance." 

" All this while the purging continued frequent, and exhibited nothing but 
a thin toatery matter or mucus. In many, the stomach became at last so ir- 
ritable, that nothing could be got to rest upon it; but every thing that was 
drank was spouted out immediately; without straining or retching. The 
countenance and extremities became livid, the pulsations of the heart more 
quick, frequent and feeble; the breathing began to become laborious and 
panting ; and, in fine, the whole powers of life fell under such a great and 
speedy collapse, as to be soon beyond the power of recovery. In this pro- 
gression, the patient remained from three to five or six hours from the ac- 
cession of the spasms ; seldom longer. These began at last to abate, but 
with more internal oppression, great jactitation, panting and gasping for 
breath, from the diminished action of the respiratory organs; for there were 
no marks of oppression or effusion on the lungs; and the motion of the heart, 
so long as it could be felt, became more and more quick and irregular, till 
death came at last to the relief of the miserable sufferer. Sometime be- 
fore that event took place, the spasms gradually abating, left the sufferers 
entirely, and so much possession of their faculties did they retain, that they 
would continue to talk sensibly to their messmates, to the last moment of their 
life, even when the %chole body had become perfectly cold, and all pulsation of 
the heart had ceased for a long time to be distinguishable." 

" About the middle of July, 1782, I entered on duty at Madras hospital. 
Here, again, I had occasion to see many more cases of the mort de chien. 
It was frequent in the fleet in the month of August, and beginning of Sep- 
tember, the season at which the land wind prevails on this part of the coast. 
We had some cases in the hospital in the end of October, and in November 
after the monsoon, but few in comparison." 

[Mso by Birdleston.] Although Cholera would thus appear to have been of 
limited prevalence in the naval hospital at Madras, in October, 1782, its in- 
fluence was most severely felt at that period by the newly-arrived troops 
from England, as stated by Girdleston in his essay on spasmodic affections of 
India. — He observes, " spasms were the first disease which appeared amongst 
the troops who arrived at Madras in October, 1782, under the command of 
Major General Sir John Burgoyne. More than fifty of these fresh men were 
killed by* them within the first three days after they were landed in that coun- 
try, and in less than a month from that time, upwards of a thousand had suf- 
fered from attacks of this complaint." 

" The symptoms which commonly first presented themselves were coldness 
of the surface of the body, especially of the hands, feebleness of the pulse, and 
spasmodic contractions of the lower extremities, soon extending to the mus- 
clesof the abdomen, diaphragm, and ribs. As the spasms advanced, the muscles 
might be seen to assume the rigidity of cartilages; sometimes causing the 
body to remain immoveably extended, sometimes bending the trunk through 
its whole length, anteriorly ; and sometimes, though seldomer, backwards. 
The parts in which the spasms began generally remained rigid ; but those 
which were subsequently seized with them, had momentary intermissions of 
the contractions ; the only intervals of relief experienced by the patient from 
the most tormenting pains. The hands and feet then generally became sodden, 



Ill 

with cold sweat, the nails livid, the pulse more feeble and frequent, and the 
breath so condensed as to be both seen and felt, issuing in a cold stream, at a 
considerable distance. The thirst was insatiable, the tongue whitish, but 
never dry; vomitings became almost incessant; the spasms, cold sweats, and 
thirst, increased with the vomitings; which last, if not checked, soon termi- 
nated the existence of the patient." " In this manner, most commonly, was the 
succession of phenomena; but often they were so rapid in their attack, that 
they seemed to seize the patient all in conjunction instantaneously." 

" In some few, the extremities remained warm ; in others, also, the spasms 
were only clonic or convulsive. Some died in the first hour of the attack ; 
others lived a day or two with remissions ; when they died, either of univer- 
sal spasms or an apoplexy. On dissection of the bodies after death, it appear- 
ed that no injury hail been sustained by the brain, liver, gall-bladder, stomach, 
or heart. The prognosis of this disease is formed with greater certainty from 
the-warmth or coldness of the extremities, than from either the universality 
of the spasms, or the frequency or steadiness of the pulse. Thus, if the spasms 
were ever so general, with warmth of the extremities, there was no immediate 
danger : on the contrary, if the spasms were ever so trifling, with coldness, 
there was every danger to be feared." 

Girdleston, like Bontius, treats of the "spasms" as an idiopathic disease; 
yet it is obvious from his observations on the prognosis, that spasm was merely 
a symptom, and one of secondary importance. He has not noticed purging, 
and from the casual way in which vomiting is mentioned, it seems doubtful 
whether we are to consider purging to have been inadvertently omitted, or 
that it really was not present, as has often been observed to be the case on 
late occasions. It is accordingly assumed that the " spasm," described by 
Girdleston was, in fact, the Spasmodic Cholera, or Mort de Chien of Curtis. 

It is also noticed in the Bengal Report, that in the month of April, 1783, 
Cholera destroyed above 20,000 people, assembled on occasion of a festival 
at Hurdwar; but it is said not to have extended to the neighbouring country. 
All these authorities would seem accordingly to establish the fact of the pre- 
valence of Cholera in India; and especially of its existence during the period 
extending from 1769-70 to 1787, when we find the first notice of the disease 
in the records of this office as given in the extracts, page 239, and which we 
now come to consider. 

[Dr. Baffin's account of it at Vcliore, in 1787.] Dr. Duffin, in a letter dated 
the 28th October, 1787, says, " I returned yesterday from Arcot, where I had 
an opportunity of seeing the situation of the sick. The Cholera Morbus 
rages with great violence, with every symptom of putrescency, and so rapid 
in its progress, that many of the men are carried off in twelve hours' ill- 
ness." Dr. Duffin considered the disease to depend on putrid bile: he re- 
commended castor oilj external heat, frictions, and the internal exhibition of 
warm cordial drinks, as the plan of treatment he had always found successful. 
In a subsequent letter, dated the 3d of November, he enters more fully on the 
nature of the disease. " The symptoms were generally pretty much the same 
in all I have seen, only the violence of the spasms was greater according to 
the stamina of the patient, and the quantity of putrid matter in the primae 
viae. They are generally seized with a nausea, frequent heats and chills, 
a dryness of the skin, and numbness and uncommon sensation, as they ex- 
press it, in different parts of their body. Then came on cold sweats, severe 
gripings, and mostly a purging of bilious colluvies, appearing often in fer- 
ment like yeast, and not unlike it in colour, with a putrid offensive smell, 
retchings to vomit, often bilious, and at other times scarce any thing is 
brought up but the liquor that is drank ; an intense thirst, oppression on the 
praecordia, with difficulty of breathing ; frequently the spasms begin with the 
first attack, though sometimes they only appear as the disease advances, and 
then generally affect the lower extremities, afterwards the abdominal muscles ; 
and the whole system becomes convulsed. The pulse from the first sinks, 
and at times is scarcely to be felt; profuse clammy cold sweats, and a pallid 
hue overspread the body ; the countenance ghastly, the eyes sunk, and the 
voice scarcely to be heard, with great dejection. The tongue in general 



112 

moist till near the close of the disease, when it becomes dry and foul, and the 
breath offensive; the urine generally pale and in small quantity." 

It is to be observed, that Dr. Duffin, at the period in question, was stationed 
at Vellore, about 14 miles from Arcot; and that his description of the Chole- 
ra could not be founded on any lengthened observation of the cases at the 
latter station, since he only made a very short visit to to it. There seems 
some reason to doubt, therefore, whether he was not describing partly what 
he saw at Arcot, and partly what he had more experience of at Vellore, 
where the Cholera was then also raging, but not in a very dangerous degree. 
His confident allusion to the bilious nature of the contents of the primoe viae, 
and the success of castor oil in curing the disease, may lead us to suppose 
that at Vellore he had in fact to contend chiefly with the Cholera Morbus, as 
it is commonly termed, not with the Epidemic or Spasmodic Cholera. This 
conclusion is supported by a reference to the sick returns, which happen in 
this instance to be somewhat less meagre and imperfect than they generally 
are found to be at that distant period. 

It appears that, during the month of October, 1787, twenty-two Europeans 
were admitted into hospital with " Cholera Morbus" at Vellore, and two 
natives ; of whom it cannot be ascertained that any died, for the returns of 
that period do not show the disease from which the casualties arose ; how- 
ever, only two Europeans died during that month at Vellore from any dis- 
ease, and not one native. At Arcot, on the contrary, 35 Europeans are en- 
tered in the sick returns, under the head of" Cholera Morbus," in October, 
1787, but no natives ; and 25 Europeans died that month, a number which 
falls short of what Dr. Davis distinctly attributes to Cholera alone. In No- 
vember, 45 Europeans are returned^at Vellore under the head of " Cholera 
Morbus," and one native ; only one European died that month at Vellore. 
At Arcot, 17 Europeans are returned in November as ill with " Cholera Mor- 
bus;" only one death took place in all, but during this month, it seems to 
have slightly affected the natives, 12 being returned, of whom none died; 
there were at this time four regiments of native cavalry quartered there. It 
seems reasonable, therefore, to infer that the disease prevalent at Arcot, and 
described by Mr. Davis as " spasmodic affection of the nervous system," was 
not the same, in general, with that which existed at Vellore, unless we im- 
pute a degree of efficacy to castor oil which can hardly be admitted. 

[Dr. Davis's Account of it at Arcot, in 1787.] Mr. Davis, a member of the 
then Hospital Board, appears to have been deputed from Madras to investi- 
gate the nature of the sickness which prevailed at Arcot. In his report to 
the Board, which is dated the 29th of November, 1787, he states as follows: 
" I found, in what was called the epidemic hospital, three different diseases, 
viz. patients labouring under the Cholera Morbus, an inflammatory fever, 
with universal cramps; and a spasmodic affection of the nervoas system dis- 
tinct from the Cholera Morbus. I understood from the regimental surgeon, 
that the last disease had proved fatal to all icho had been attached with it ; and 
that he had already lost seven-and-twenty men of the regiment in a few days. 
Five patients were then shown me with scarce any circulation whatever, to 
be discovered ; their eyes much sunk within their orbits; their jaws appa- 
rently set, their bodies universally cold, except at the praecordia, and their 
extremities livid. Mr. Pringle observed that these five men were attacked 
on the 26th October, that Mr. Duffin had seen them, and had recommended 
castor oil to be administered, &c. &c." 

He then goes on to say, " finding on the day of their attack, the rectum 
had discharged its contents in the action of straining to vomit without being 
able to bring any thing up, I directed a stimulant injection to each of these 
patients which produced a copious discharge of feeCes, without any bilious in- 
duration (indication ?) whatever." Having prescribed some antispasmodic 
medicines, he. says, " from all which I had the pleasure to observe, that in 
four-and-twenty hours after my first visit, the spasms had totally subsided, 
the patient's voice, which all along had been so low as scarce to be heard, 
was returned almost to its natural state; the pulse that was imperceptible, 
full and even." After ordering some carminating purgatives, he observes, 



113 

" I attended to the operation of these respective medicines, and could disco- 
ver no bilious indication in the whole system." 

Two of the five patients having died in a few minutes after being taken 
out of a hot medicated bath, " upon dissection the duodenum was found dis- 
tended with putrid air; the other intestines empty, except the colon and 
rectum, in which latter there were indurated faeces; the whole viscera sound, 
the gall-bladder turgid, but not diseased !" 

Mr. Davis does not state the symptoms of the "inflammatory fever with 
violent cramps," farther than that the patient complained of a " tightness of 
the abdomen with a costive habit." The " cholera morbus" was distinguished 
by "spasms of the praecordia, and cramps of the extremities, with bilious li- 
entery, and a copious discharge from the stomach of a green, yellow, and 
dark-coloured bile. During his residence at Arcot, upwards of sixty pa- 
tients labouring under these three forms of disease were admitted, and only 
two or three deaths ensued. The dissection of a case is given, where, it is 
stated, " the bladder was most singularly contracted, and did not exceed in 
size a large nutmeg, yet without inflammation, or any apparent disease, ex- 
cept its contracted state." 

[Mr. Thompson's account of it, at Arcot and Trincomalee.] Mr. Thomp- 
son, surgeon, who was also sent to Arcot at the same time with Mr. Davis, 
observes, " This disease is exactly the same as prevailed at Trincomalee in 
the months of April and May, 1782, when the season was very hot and 
chill, the winds blowing from the land, and reaching some leagues to sea. 
The weather here at present is the same as I experienced at Trincomalee." 
Mr. Thompson also gives an account of a dissection where " the gall-blad- 
der was exceedingly distended with bile, so much so as to appear protruded 
some inches below the liver, and to contain near six ounces of-bile. No 
marks of putrescence in any of the abdominal viscera. The urinary bladder 
quite empty and contracted to the size of a walnut; the stomach and duode- 
num both empty of bile, and no appearance of inflammation in any part of 
the intestinal canal or peritoneum." 

To persons familiar with the progress of Cholera during late years, there 
can be little difficulty in understanding and reconciling the apparent discor- 
dances in the accounts just quoted. Many instances of the common Cholera 
would seem to have occurred at Arcot, as well as at Vellore, where, it has 
been conjectured, this form of the disease chiefly prevailed. Some cases 
seem to have commenced with a degree of febrile excitement, an occurrence 
which has been occasionally observed in the present epidemic ; or perhaps, 
these cases might be properly referred to a species of febrile affection with 
cramps, of which we have a very distinct history by Mr. Anderson, who ob- 
served the disease at Ellore in 1794, and styled it a " Causus ;" lastly, that 
which Mr. Davis characterises as a " spasmodic affection of the nervous 
sytem distinct from Cholera Morbus," was no doubt the same low and dan- 
gerous form of the disease with which we have become too well acquainted 
in recent times. 

The disease would seem to have lost its force at the period when Mr. Da- 
vis arrived at Arcot; for we find that the five cases, of the low form, which 
he first saw, had lingered from the 26th to the 29th ; and few of the subse- 
quent seizures proved fatal, which is quite analogous with our present expe- 
rience. — Whether the bowels were less generally affected in that epidemic, 
or whether the means employed, and the prolongation of life for three days, 
had given rise, in the cases in question, to faecal formations, and to their 
accumulation in the large intestines, it is not easy, from the scantiness of 
our information, to decide. But, if any doubt could be entertained of the cases 
described being Cholera, such as we have lately witnessed, the testimony of 
Mr. Thompson to their identity is conclusive, if we admit that the mort de 
chien of Curtis, which he states to have prevailed at Trincomalee at the 
time mentioned by Mr. Thompson, was really Cholera. 

\_Cholera noticed in 1790 in the Northern Circars.] It is stated in the Cal- 
cutta report, that " Cholera was again very prevalent and destructive in a 
detachment of Bengal troops marching through the Northern Circars, in the 



114 

months of March, April, May and June, of 1790. " The disorder was cha* 
racterised by precisely the same symptoms which marked the late epidemic. 
It began with violent pain and spasm in the stomach and bowels ; which were 
followed by purging, vomiting, and all the signs of extreme debility." 

[Noticed by Dr. James Johnson.'] The next account we have of Cholera is 
to be found in Dr. Johnson's work on the diseases of the tropical climates. It 
does not appear in that work, that Cholera was then epidemical, but it would 
seem to have occurred pretty frequently, both on shore, and on ship board, 
chiefly in the vicinity of Trincomalee. The precise date is not mentioned; 
it is concluded," however, to have been about 1804. Dr. Johnson does not 
detail the symptoms with much minuteness, contenting himself with those 
occurring in one or two cases, and referring generally to Curtis's description 
of the disease, a pretty satisfactory proof that they were the same. A sea- 
man on awaking after a debauch, repaired to the deck, and there again fell 
asleep, during the chilly part of the night. " About 4 o'clock in the morn- 
ing, he awoke with a shiver and left the deck, but was soon seized with fre- 
quent purging and griping, his stools consisting of mucus and slime. Nausea 
and retching succeeded; nothing being ejected but phlegm, and the contents 
of the stomach. His pulse was now small, quick, and contracted; his skin 
dry, but not hot. About eight o'clock in the morning he began to feel 
spasms in different parts of his body, which soon attacked the abdominal 
muscles, and threw him into great pain. During these paroxysms, a cold 
clammy sweat would be occasionally forced out, especially in the face and 
breast. The extremities now became cold; his features shrunk; the sto- 
mach rejecting every thing which was offered, either as medicine or drink. 
The abdomen and epigastrium all this time were distended and tense, with 
incessant watery purging and painful tenesmus. By ten o'clock his pulse 
could scarcely be felt: his breathing was oppressed and laborious, his eyes 
sunk, and the whole countenance singularly expressive of internal agony 
and distress. The extremities were cold, shrivelled, and covered with 
clammy sweats. The violence of the spasms now began to relax; and by 
eleven o'clock, or seven hours from the attack, death released him from his 
sufferings." " This may serve as a specimen of the worst form of that 
dreadful disease, which has obtained the appellation of " mort de chien," or 
the " death of a dog." 

[Cholera supposed to have been met with at various times since 1787.] 
Since Cholera has become familiar to the older practitioners here, many, 
perhaps all of them, recollect having met with insulated cases of that dis- 
ease, as well as of sudden, and often fatal illness, which they, at the moment, 
could not well understand, and which consequently, proved extremely em- 
barrassing. Such cases would no doubt be attributed by different practition- 
ers to different causes, and be referred to different heads of disease, accord- 
ing to the various states in which the patients were seen; and, perhaps 
some of them were considered to be merely anomalous instances of common 
Cholera ; but late experience has now very generally led to the opinion, that 
they were, in fact, cases of Spasmodic Cholera. The records of the medical 
board throw no light on this subject. The number of cases of the description 
alluded to, which may have entered the military hospitals, could not how- 
ever, in all probability, have been great, without attracting observation. It 
might perhaps be thought that the necessity of classing the cases in the offi- 
cial returns would have led to their being detected by a bare inspection of 
these documents ; but in the absence of any nosological arrangement, which 
then distinguished the returns, no difficulty would be experienced in dis- 
posing of them. 

Sporadic cases of Spasmodic Cholera might naturally produce the impres- 
sion that some poisonous matter had been swallowed, which other circum- 
stances would contribute to render sufficiently plausible; for, it is notorious, 
that intoxicating liquors are prepared by the natives, and clandestinely sold 
to the European soldiery, which contain the most deleterious matters, and 
which often produce fatal consequences to those who drink them. The symp- 
toms attending such cases are frequently very anomalous and perplexing. 



115 

Although the natives are less prone to debauch in spirituous liquors, they 
are yet not altogether to be exempted from the reproach ; and the notion of a 
poison having been swallowed, would, in their case, be rendered still more pro- 
bable, from such occurrences being not unknown amongst them, and from 
our ignorance of the nature of the poisons which are used. 

It must be admitted, however, that very few cases either of sudden death, 
or poisoning, or Cholera, are to be found in the returns; but it will be pre- 
sently shown, that no positive conclusion can thence be drawn against the 
existence of Spasmodic Cholera prior to the year 1818, when it appeared epi- 
demically in these territories; and that some at least of the cases designated 
as Cholera in former times, were clearly of the spasmodic species. 

[Described by Mr. J. Wyllie in 1814.] Mr. John Wyllie, in his report, 
dated 20th July, 1818, (page 68) makes the following remarks: " Before 
concluding, I think it proper to add, that although I have never, before the 
late occasion, seen this peculiar disease prevailing as an epidemic, yet I have 
at various times met with single cases of it in the most aggravated form, and 
I am much mistaken, if I have not recorded two particular instances of it in 
my journal of the 1st battalion 24th regiment, for the month of June, 1814, 
under the names of Paramuttee, and Madaramooto, sepoys." On referring 
to these cases which have been preserved, Mr. Wyllie's conjecture seems to 
be fully confirmed. The first case is thus described : " Jaulnah, 19th June, 
1814, P. M. 2 past 2. He is in a state of the most extreme exhaustion, unable 
to move or speak, features contracted ; eyes sunk, half open, and of a dull 
lustre ; countenance bedewed with a cold sweat; pulse low, skin cold. Has 
been vomiting and purging very frequently since 7, A. M. and had all yester- 
day been affected by a watery diarrhoea ;" at 3, P. M. he " is greatly distress- 
ed by excruciating crampy pains of the thighs and legs;" at 9, P. M. " com- 
plains of thirst, tongue moist ;" on the 20th he " continues very low ; coun- 
tenance still of a ghastly appearance ;" " alvine discharges copious, alone of 
ash-coloured slime." The patient recovered. The next case is on the 24th 
June, 7, A. M. " Is in great distress from violent crampy pains of the mus- 
cles of the upper and lower extremities, but more particularly of the fingers ; 
there is great prostration of strength ; countenance ghastly ; surface cold ; 
pulse gone ; much thirst. He had a very copious watery purging on him 
since one o'clock this morning. He attributes his complaints to having slept 
last night on the damp ground, and in the open air, while on guard ; at 9, 
A. M. " pulse just perceptible ;" at 2, P. M. "slight giddiness, eyes red, says 
he has much appetite;" at 6, P. M. " one copious pale watery evacuation." 
This man also recovered, and both were treated with opium, and diffusible 
stimuli. 

[Also by Mr. Cruickshanks in 1814.] Another incidental notice of Cholera 
has led to the discovery of that disease having prevailed to a remarkable ex- 
tent, at the same time, and much in the same neighbourhood, as in the pre- 
ceding instance. The late Mr. J. J. Duncan, in a report dated 1st Septem- 
ber, 1819, after making some observations on the comparative advantages of 
dry and moist heat, externally applied, goes on to say, " in the month of June, 
1814, when the Cholera appeared with great severity, in the 1st bat. 9th regt. 
N. I. on its march from Jaulnah to Trichinopoly, I employed exactly the 
same plan of exciting heat, (heated sand,) and found the greatest benefit re- 
sulting from it." " The disease in the 9th regiment in 1814, resembled in 
every particular, (with the exception of the heat at the praecordia,) the Cho- 
lera at present so common, although it could not be called epidemic. The 
best behaved, the most robust, and the most active, were attacked, and suffer- 
ed equally as much as any patient I have seen with the Epidemic Cholera; 
out of a very considerable number of patients I only lost one man; the num- 
ber I could not specify, as I was ordered back to Jaulnah on duty about ten 
days after the appearance of the disease, and before the monthly returns were 
dispatched." 

On referring to the returns of that corps, it appeared, that in the month of 
June, 1814, ninety-nine cases of " bowel complaint" were entered, of which 
fourteen proved fatal ; and about sixty cases of the same disease were ad- 



116 

mitted in the succeeding two months, of which, however, very few died. As 
these returns made no allusion to Cholera, and as they were signed by Mr. 
Cruickshanks, a reference was made to him for information, respecting the 
preceding observations of Mr. Duncan, which has drawn forth the very va- 
luable report inserted at page 234, and bearing date the 17th June, 1823. It 
now appears, that a brigade of two battalions of N. I. marched from Jaulnah 
on the 29th May, 1814, and that about the 10th or 11th of June a disease 
broke out in one of the corps which there can be no doubt was the Spasmo- 
dic Cholera. " When taken into the hospital," Mr. Cruickshanks observes of 
the first cases he saw, " they exhibited ait those symptoms now so well known, 
of per sons labouring under the advanced and fatal stage of Epidemic Cholera; 
the skin cold, and covered with cold perspirations ; the extremities shrivelled, 
cold, and damp ; the eyes sunk, fixed, and glassy, and the pulse not to be felt. 
These persons all died, and I find, on referring to such notes as I have pre- 
served, that, influenced by consideration of the vascular collapse, and total 
absence of arterial pulsation, I had denominated the disease Asphyxia. Many 
sepoys were brought into hospital in circumstances approaching to those 
above detailed. Of th-em, in a considerable proportion, the disease terminated 
fatally. Thus the cases which I first saw of this malady, in the aged, among 
the camp followers, differed in no respect from the worst cases of that affection 
since so well known under the name of Spasmodic Cholera. That name, how- 
ever, I did not adopt, neither in my public reports, nor in the private notes 
which I took at the time. In this I was chiefly influenced from considering 
the nature of the matter ejected by vomiting and by stool, which in Cholera 
is said to consist of bile, but which in these cases was aqueous or mucilagi- 
nous. Besides, it is evident that the diiulent treatment, recommended in 
Cholera, could never be applicable to such a disease as that with which I had 
to contend. I continued therefore to employ in my reports the term " bowel- 
complaint," both because I found it in the hospital books on joining the corps, 
and because, if it conveyed no very precise idea of the malady which it was 
meant to designate, it was at least an appellatiou whence no erroneous im- 
pressions could be derived." 

This paper by Mr. Cruickshanks is of great importance, inasmuch as it 
evinces that Cholera did exist to an extent not hitherto suspected to have oc- 
curred at so recent a date ; and also that even under these circumstances, no 
trace of it is found in the public records, for, unless we had been guided by the 
■incidental remark of Mr. Duncan, made five years after the occurrence, and 
had most fortunately been able to refer to Mr. Cruickshanks, the medical re- 
turns of the corps never could have led to a knowledge of it. Hence, as al- 
ready observed, though Cholera very rarely appears in the sick returns of 
former times, it is by no means from thence to be inferred that it did not then 
exist . 

But this paper is also peculiarly valuable, as showing that the Cholera as- 
sumed, on that occasion, one of those singular and unaccountable features 
which it has frequently manifested in the present times ; for, after enumerating 
various striking atmospherical vicissitudes, change of food, and many other pre- 
disposing, remote, and exciting causes of disease, to which the brigade had been 
exposed, Mr. Cruickshanks goes on to observe, " To none of these causes of 
disease which I have enumerated, did the natives themselves attribute the 
sickness and mortality which prevailed; and on considering that of two bat- 
talions composing the brigade, alike exposed to all those causes, one only suf- 
fered from the epidemic, the hospital of the bth K.I. exhibiting not a single case 
of analogous disease, those adduced can only be regarded in the light of re- 
mote or predisposing causes ; while, something or other, acting exclusively 
on one battalion, must be sought for as instrumental in exciting the malady." 
We shall have occasion hereafter to revert to this particular subject; at pre- 
sent it is mentioned as showing that Cholera did, even then, manifest one of 
the most curious of its features, namely, that of two bodies of men, apparently 
under similar circumstances, one shall be attacked by it, and the other shall 
escape. 



117 

[Mr. Hay considers it to he endemic in Travancore.} It would also seem, by 
the subjoined extracts of reports from Mr. Staff Surgeon Hay, that Cholera, 
in a form nowise different from the spasmodic or epidemic, is endemical in 
the Travancore country, and that he regarded the disease which appeared 
there in October, 1818, to be this endemic, rather than the epidemic, whose 
approach from the northward he still contemplated. On the 19th of Novem- 
ber, 1818, Mr. Hay writes; "the Spasmodic Cholera, I am happy to say, 
abates; the last seven days not having afforded more than thirty-six cases 
at Quilon, and there has been no casualty here in that time; but the Vy- 
thians, who arrive from the country for instruction and medicines, report the 
deaths of almost all attacked." After acknowledging the receipt of some 
medical supplies, he continues, " I trust to be able to make a noble stand 
against the epidemic when it arrives; what I have had to encounter recently 
I hold to be the endemic Veshoo-ugeka, or Neer-comben, if not of the Mala- 
bars, certainly of the Travancorians, which is perfectly familiar to all here; 
committing frequently great mischief, and sometimes (25 years since) deso- 
lating the country. Ten thousands are said to have died of it; the Vythians 
fled from it as a plague, and no one who has not early succour from suitable 
medicines, is ever known to recover;" " the description of the Veshoo-ugeka 
tallies in every particular with that of the Spasmodic Cholera; and whether 
the epidemic reaches us or not, the country will have reason to be thankful 
for instruction and remedies they never might have had, unless the danger- 
ous inroad of the epidemic had been apprehended. In May last, at Trevan- 
deran, the capital, one hundred lives were sacrificed to this Veshoo-ugeka 
(poisonous air) : some of the servants of the palace were seen by Mr. Pro- 
van's assistants, and saved, but the villagers around, having no assistance, 
died to a man." Again, on the 24th December, 1818, Mr. Hay writes: " The 
Neer-comben, which signifies gush of water by stool, the effect of the disease, 
and its synonyme Veshoo-ugeka, or poisonous air, its imputed cause, which 
are the vulgar and scientific designations of our present Spasmodic Cholera, 
has been very prevalent amongst the troops, their families and followers. In 
Quilon I have treated upwards of 120 under the Spasmodic Cholera, and of 
the inhabitants a considerably greater number, with complete success in 
every case where application was made within six hours; and hundreds have 
been saved by the use of the remedies I have distributed throughout the coun- 
try. This shows unusally, for be it remembered, that to the central parts of 
the Travancore coast, and parts quite adjacent, so far as my reports inform 
me, the endemic has been principally confined, and it is of this I speak; but 
the epidemic also now rapidly progresses southward, having already at Co- 
chin yielded Mr. Mather some hundreds of patients, and at Aleppy about 
30 per diem are taken ill; as it nears us, I become more apprehensive that 
the mortality will be great, for, although medicines, with ample instructions, 
have been distributed to 140 Vythians and others in the country, yet, from 
the experience 1 daily have of their general inattention, I much fear that 
when the day of visitation and trial arrives, the sick will be found too often 
left to their fate, altogether unassisted." Mr. Hay goes on to state, that in 
some villages where there was no medical aid, from three or four to ten peo- 
ple were dying daily of the endemic, and, talking of the zeal of the Vythians, 
he observes, " but when the same malady (Spasmodic Cholera) was epidemic 
here 34 years since, they ran from their charge, under the persuasion that 
the disease was contagious, for many died, and numbers in one family." 

There can be no doubt, however, that the disease described here as an ende- 
mic, was, in fact, the Epidemic Cholera of other parts ; and no particular mani- 
festation of it took place afterwards at Quilon in regular course from Cochin 
and Aleppy, as seemed to have been expected by thestaffsurgeon, nor, indeed, 
until July and August following. The progress of Cholera as an epidemic 
along the western coast, however, was much less regular than in other tracks, 
which may perhaps be attributed partly to the geographical peculiarities of 
that coast, and partly to the disease being in some degree endemic, which 
would not only accelerate the invasion and march of an epidemic of the same 
nature, but also render it difficult to fix the precise dates of its appearance. 

P 



118 

[Epidemic Attack of Cholera in Travancore, about 1790, and in the Ceded 
Districts about the same Time.'] Mr. Hay mentions, in the first letter, that 
Cholera committed great ravages in the Travancore country " 25 years since," 
and in the second letter, that " it was epidemic 34 years since;" either of 
these dates, supposing that there was only one visitation meant, would prove 
the existence of Cholera, epidemically, at a period considerably ulterior to 
1787, and of course anterior to the instance in the 1st battalion, 9th regiment; 
and the whole communication shows that the disease is at no time of rare oc- 
currence in that country. There is a very fatal form of disease also known 
in Travancore, called " the red eye sickness" by the natives, which is evident- 
ly a modification of Cholera. Mr. Superintending Surgeon Duncan (page 110) 
also observes, " I find the old inhabitants of Bellary are acquainted with this 
disease, and inform me that it raged here about 30 years ago, with great vio- 
lence. This was succeeded by a famine for want of inhabitants to cultivate 
the country." 



(B.) — Referred to page 47. 
Deaths from Cholera for the last ten years in Philadelphia. 



Years. 


Under 10 years o 


fage. 


Over 


10 years 


of age. 


Total. 


1822 


. 


199 




. 


"13 


- 


212 


1823 


. 


252 


. 


. 


13 


. 


265 


1824 


. 


155 


■ 


. 


.9 


- 


164 


1825 


• 


197 


- 


- 


12 


. 


209 


1826 


. 


233 


. 


- 


11 


- 


244 


1827 


- 


229 


-- 


- 


10 


. 


239 


1828 


. . 


284 


. 


- 


7 


- 


291 


1829 


- 


239 


- 


. 


18 


. 


257 


1830 


- 


232 


- 


. 


4 


- 


236 


1831 


- 


303 


- 


- 


17 


- 


320 



2,323 114 2,437 

In the Reports of the Board of Health, from which the above statement is 
made, the disease in infants is usually designated by the term Cholera Infan- 
tum, that in adults as Cholera Morbus. 



(C .) — Referred to page 101. 

THE USE OF TOBACCO ENEMATA IN CHOLERA. 

Case of very malignant Cholera, in which all the symptoms were well 
marked, cured by the administration of the tobacco enema. — Ralph Crow, 
eetat. 65, was taken ill about 6 o'clock in the morning of the 28th December, 
1831. A medical friend invited me to see him about twelve o'clock at noon, 
when I happened to be in Gateshead, where the patient resided. He was at 
that time very ill indeed, and his condition appeared certainly hopeless. His 
eyes were sunk, the palpebral black and drawn within the orbits. His nose 
and lips livid. Tongue white and cold ; and his voice quite gone. Indeed 
the whisper could with difficulty be understood. The skin of the hands and 
fingers was much sodden, and the nails very blue. Pulsation was not to be 
felt at the wrist, and the surface of the whole body was completely cold. 
The secretion of urine was entirely suspended. He was suffering from 
cramps in most of the muscles. There were incessant vomiting and frequent 
dejection from the bowels, of pellucid fluid, mixed with flakes resembling 
boiled rice. I had felt desirous for a day or two to observe the effects of a 
moderate dose of the tobacco infusion in the form of enema, in this intracta- 
ble complaint. I availed myself of this opportunity, although a formidable 
instance to begin with. Half a drachm of tobacco, prepared with half a pint 
of boiling water, was administered. This was retained in the intestines. In 



119 

a few minutes the skin became warm, and a clammy moisture was observed 
upon it. He vomited after it very copiously two or three times. About a 
quarter of an hour after giving the enema the pulsation at the wrist was evi- 
dent. I cannot refrain from expressing my obligations to my medical friend 
in Gateshead, who was so obliging as to repeat the injection in the evening, 
because he observed the advantage of the practice in the morning. This he 
did of his own accord, as nothing passed between us respecting any repeti- 
tion; the unfavourable state of the patient rendering it probable that it would 
not be required. It was observed at both times that as reaction took place, 
the colour of the integuments, and partciularly the lips, became changed to 
a more healthy hue. 

Dec. 29, 12 o'clock. — Revisited the patient, whom I found much better. 
The warmth and natural hue of the skin had in a great measure returned. 
The countenance was improved ; pulsation at the wrist distinct and regular; 
vomiting and purging had ceased; tongue warm and less white; muscular 
spasms relieved, and he had enjoyed some quiet sleep. Other remedies were 
now exhibited to act upon the secretions, which all went on progressively 
improving. This man, during many days, retained the appearance of having 
recovered from a dreadful state of disease, but was completely restored to his 
strength in a few weeks. 

Case of malignant Cholera, wherein Tobacco enema was administered 
with effect at the time, but the patient sunk afterwards. — Helen Douglas, 
eetat. 55, a very fat woman, whose occupation was to sit at a stall for the 
sale of vegetables, &c, in a confined filthy street in Newcastle, was at- 
tacked with symptoms of Cholera on the 2d January, 1832. The early 
symptoms were extreme, and sudden discharges from the bowels and sto- 
mach, of a fluid resembling rice-water. A medical gentleman was applied 
to in the night, but did not visit her. She was visited by me about ten 
o'clock of the following day. She was complaining of violent pain in the 
hypogastric, and epigastric regions, and in the back. Her countenance was 
very much sunk and livid. The hands and fingers sodden. The cellular 
substance of the arms was condensed and inelastic, resembling dead integu- 
ment. The pulse was imperceptible at the wrist, but might be felt beating 
feebly in the carotids. She had passed no urine for some time ; the body 
was very cold ; and she suffered much from cramps and spasms in the abdo- 
minal muscles, and in thoee of the extremities. Her tongue was white, and 
nearly resembled white leather; and the breath was cold. An injection, 
containing half a drachm of tobacco in infusion, was immediately adminis- 
tered. About fifteen minutes after the injection was thrown up, pulsation 
became very perceptible at the wrist. Slight perspiration was observed 
about the central parts of the body, and the countenance became improved 
in appearance. She still was ejecting large quantities of fluid from the sto- 
mach. An hour and a half afterwards, she had vomited some yellow fluid 
mixed with white sediment. The pulsation and perspiration still continued. 
She was ordered to take five grains of calomel every hour. 

Four o'clock, P. M. — The spasms have returned : pulse more feeble : still 
complains of constant pain in the abdomen. I attempted to bleed her from 
the arm, to unload if possible the venous circulation. By constant friction 
up the course of the vein, I succeeded in getting away about four ounces of 
very black thick blood, guttatim. Three scarifications were applied to the 
abdomen, but the blood stood in the incisions like tar. A common fomenta- 
t ion was directed to be applied over the abdomen. The tobacco enema was 
again exhibited, which produced a little faintness at the time, from which 
she soon recovered. 

Nine o'clock, P. M. — Her countenance is better, but the pulse not quite so 
good: still suffers from cramps, although not so severe. Pain of hypogastric 
region and back, but it has abated in the praecordia. She has vomited very 
little; has felt frequent desire to empty the bowels. A small quantity of thin 
dark fluid was evacuated. As she had experienced much desire to pass urine, 
I placed my hand over the hypogastric region to ascertain the state of the 
bladder, and was astonished to find every thing about her wet and cold. 
Upon inquiry I found it was from the flannels used for fomentation, which 



120 

were absurdly left to cool since four o'clock, until I discovered them. Take 
castor oil. 

Jan. 4. — She has had no vomiting all night. Towards morning passed two 
small fluid bilious stools. Continued to complain of pain in the hypogastric 
region. I was prevented seeing her until eleven o'clock, when I found her 
sinking rapidly, and she soon after expired. I had taken a catheter with me 
to introduce, as I understood from my assistant, who brought me the report 
in the morning, that she expressed a very anxious desire to pass urine. 
Finding her so near death I did not attempt it. The blood drawn yesterday 
was coagulated, very dark and devoid of serum. Other cases are given ;by 
Dr. Kirk, of the successful effects of this remedy. 



(D.) — Referred to page 104. 

[Sketch of the Practice of three eminent and excellent Practitioners &t New- 
castle] — I shall now (says Dr. Kirk) lay before the public a short summary of 
what I understood to be the treatment of this disease, by a very eminent and 
excellent practical surgeon, Mr. John Fyfe, of Newcastle. At the time I was 
in Newcastle, he had attended 579 cases of Cholera; and in all these, he says 
that collapse never came on till after profuse serous discharge from the bowels. 
Mr. Fyfe relies very much on stimulating enemata ; and he says that they 
seldom fail to produce reaction in its most salutary form, attended by less 
congestion than that which followed collapse of longer duration, in which 
stimuli had been withheld, or when the most diffusible stimuli had been given 
by the mouth. When watery diarrhoea exists, tinged with healthy secre- 
tions, he has arrested it often at once by opium ; and in nineteen cases out of 
twenty, convalescence has followed. But if the disease has advanced, he 
then gave repeated doses of calomel : moderated the discharges by opium, 
and softened the pulse by bleeding, if necessary. If the disease proceeds to 
vomiting, purging, and cramp, Mr. Fyfe prescribes a mustard emetic, follow- 
ed by copious draughts of warm water, friction, and the proper regulation of 
heat. If the pulse is firm, blood is taken to the extent the pulse can bear. 
Calomel and opium are then used, and diluents allowed. In collapse, Mr. 
Fyfe objects to large opiates, and also to general bleeding; but, in general, 
he gives relief by throwing into the intestines three pounds very hot water, 
six ounces of brandy, and occasionally, two drachms of laudanum. It will 
be frequently necessary to withdraw these injections by a tube — they come 
off cold — and to repeat them either with hot water alone, or with laudanum, 
if the irritability of the stomach continues. In this stage Mr. Fyfe uses brandy 
liberally. He treats the reactive fever in the same way Mr. Frost does, as 
stated below, and I have already alluded to some of his ingenious adaptations 
in my report. Mr. Fyfe thinks the period of the incubation of the morbific 
germ of Cholera seems to vary from four hours to eight days. Mr. Fyfe is 
also of opinion that the effluvia, from the excretions of an individual having 
diarrhoea cholica, may communicate to another predisposed, the most deve- 
loped form of the disease. 

Mr. Frost, of Newcastle, treated 500 cases of Cholera, and is a person of 
high qualifications, a calm thinker, and an excellent practitioner. I think the 
profession will be glad to hear his opinion and practice in the disease, which 
I will give as accurately as I can recollect a conversation held with that gen- 
tleman at Newburn. He said that he conceived it a malignant congestive 
fever, — and if English physicians had seen this disease without reading Barry, 
Bell, Orton, and Lefevre, they would have treated it on scientific principles, 
and according to the rules of British art. They would have given no astrin- 
gents. The catch-word of 'stop the diarrhoea' would never have existed. He 
stopped it, but in a far different method, viz., by calomel, castor oil, and very 
minute doses of opium ; say five grains calomel, one opium, and two antimo- 
nial powder to begin with, several times repeated. If there is head-ache, and 
giddiness, and the pulse is of sufficient tone at the commencement, — if the 
pulse is from eighty to a hundred, bleed moderately. But the bleeding must 



121 

be cautious; for in this, as in all cases of intestinal irritation, bleeding cannot 
be largely practised with safety. If the stomach is much loaded, or there is 
nausea, give a draught of warm water to excite vomiting. If that does not 
effect it, you may give salt and water, or ipecacuan, or a dose of castor oil, 
which may be succeeded by a diaphoretic. This will open the skin. Next 
day calomel and castor oil again. If the castor oil will not stay on the sto- 
mach, the best substitute is magnesia and rhubarb. If the patient gets colder, 
then fill the large intestines with warm water from the forcing pump; and if 
you have any idea that the bowels are not discharged, then put salt in the 
water. After this invariable stage of diarrhoea comes that of collapse. In 
every case where correct information could be obtained, diarrhoea has pre- 
ceded it. He gives warm water to induce vomiting; injections of hot water; 
careful regulation of heat; twenty drops of laudanum to allay irritation; two 
grains of calomel, and one-sixth of a grain of opium, every three hours, for 
three times, and then castor oil. In one case, for instance, under this treat- 
ment, the pulse rose to eighty, and the patient became warm. Eight ounces 
of blood were taken from the arm. He passed no urine for forty-eight hours. 
Mr. Frost went on with the calomel, and next day the urine returned, and he 
recovered after a mild consecutive fever. He has never practised stimulation. 
The consecutive fever of children is almost always attended with the same 
symptoms as hydrocephalus acutus. The dydrargyrus cum creta is the best 
remedy for them. He has seldom been able to induce ptyalism. Worms are 
very frequently vomited. They are always dead. The injesta of Cholera 
seem poisonous to them. At Newburn, a village where Mr. Frost conducted 
a great part of the practice, two hundred and seventy-three cases of the dis- 
ease occurred up till the day on which I visited Newbern with Mr. Frost. 
Fifty of these cases were fatal. The whole inhabitants of the village were 
five hundred and fifty, one hundred and forty-one families, and one hundred 
and thirty-four houses. This is truly appalling. In general, even when the 
cold stage is incomplete, consecutive fever sets in — there is much giddiness, 
pain of the head, and stupor. He has always treated this stage with laxatives. 
Mustard sinapisms applied to the neck, relieve the head ; to the epigastrium, 
the stomach. They have often been costive, but it has not been difficult to 
manage the bowels. Leeching to the head was frequently resorted to. Now, 
I ask the reader to compare the success of this treatment with that in the 
village of Hartly, where brandy and opium were used, and where, out of 
thirty-four cases thirty-two died. 

I beg now to give the experience in this disease of an excellent friend, Mr. 
D. M'Allum. His acuteness and talents are only equalled by the excellence 
of his heart and the soundness of his principles. 

" Dear Sir — Imperfect as naturally must be, from my limited opportunities, 
my capability of replying to your queries respecting Cholera; yet so far as 
my information can contribute, in the slightest degree, towards the further- 
ance of your laudable object, 1 am happy to afford it. 

" In looking over the list of queries proposed, I do not see that my indivi- 
dual experience can afford any information worth recording, but upon the 
last, viz., the treatment found most successful. In reference to treatment, I 
would divide this disease into three stages. 1st, That of excitement, or irri- 
tation, wherein the patient throws or purges freely, generally accompanied 
by severe spasmodic action of the muscles of the legs and bowels: the pulse 
distinctly perceptible, quick, sharp, and in some subjects, full. This stage 
does not last beyond a few hours, passing on to, ?dly, The stage of collapse; 
wherein the pulse becomes imperceptible, the extremities cold, the breathing 
more laborious, the countenance more sunk, especially the eye, which as- 
sumes a leaden hue ; and 3dly, the stage of reaction. He who is happy 
enough to be called in during the first stage, willrfiot hesitate, if the patient 
have any vigour of constitution, to bleed freely, premising, or using simulta- 
neously, a gentle emetic of ipecacuanha, or salt and water, following this by 
an anodyne injection. I then administer a pill of two grains of calomel, and 
one-sixth of a grain of opium, every half hour, with chalk mixture, or saline 
julap, in a state of effervessence for a few hours, until we have dejections 
evidently combined with bile. To assist this operation, and especially if the 



122 

vomiting be still severe, I administer warm emollient injections, and after- 
wards treat as in ordinary continued fever. In this stage of collapse, or ap- 
proaching to it, I give a tea-spoonful of mustard in a little warm water, every 
five minutes, till I produce vomiting; at the same moment I order enemata 
of very warm water and soap, without reference to quantity, endeavouring 
to throw up as much as ever 1 can. These means I find more successful in 
restoring heat than any external means; but which I do not, nevertheless, 
neglect, ordering hot applications to the feet, hands, and arm-pits, and that 
the patient be well rubbed with a stimulating liniment of spirits of turpen- 
tine, tincture of capsicum, mixed with camphorated oil; I then apply the hot 
air, both which I continue at a temperature about 84, for two hours or more. 
In the mean time, as soon as the emetic has operated, I give six grains of 
calomel, one-fourth of a grain of opium, every quarter of an hour, with two 
table-spoonfuls of a mixture containing compound spirits of ammonia three 
drachms, spirits of mindererus three drachms, mixed with hot coffee, giving 
warm liquids very freely and frequently. In this stage I have tried bleeding 
repeatedly, but wtthout benefit; indeed, it seemed to me to precipitate the 
fate of the patient. The enemata ought to be repeated frequently until re- 
action takes place. The third stage, viz., of reaction requires no difference 
of treatment from that of our usual typhus mitior, excepting that bleeding 
should be had recourse to with very great caution, as I believe, by its too 
free use in improper cases, the stage of collapse has returned, and the patient 
sunk. There is generally a tendency to congestion, either of the brain or 
liver, which requires the application of leeches and blisters. The mortality 
in my own practice was during the first three weeks — exactly two to one re- 
covered, — but since January commenced [ have had seven cases, most of 
them applying early — six of them are convalescing, and one dead. In Walls- 
end township, amid a population of 3000, there have hitherto occurred 15 
cases and 4 deaths. 

" In the above observations I have merely referred to my own individual 
practice, and its results. Although I have had three patients in one house, I 
have met with no fact that could confirm the doctrine of contagion. 

" Yours, respectfully, 

" D. M'Allum. 
" Blackett Square, Saturday, Jan. 14, 1832." 



(E.) — Referred to page 103. 
ON THE TREATMENT OF CHOLERA IN INDIA. 

Mr. Annesley gives the following account of the way in which Epidemic 
Spasmodic Cholera has usually been treated under his direction*: — 

" A patient is admitted into the hospital, I shall say at noon, with all the 
symptoms of Cholera: a vein is immediately opened, and one scruple of calo- 
mel and two grains of opium are given in the form of a pill, and washed 
down with the camphor draught. The body and extremities are well rubbed 
with dry flannels made warm, and bottles filled with hot water are applied to 
the feet and hands; but if the spasms are severe, spirits of turpentine are 
used as an embrocation. In an hour we generally perceive the effects of 
these remedies, and whether the disease be in any degree arrested, or be pro- 
ceeding in its progress. If the former, nothing more is to be done till even- 
ing, when the calomel pill may be repeated, and an enema exhibited. The 
following morning the bowels should be again fully evacuated, and then the 
patient may be considered safe. 

" When blood, however, cannot be drawn from the arm, and the spasms 
continue; when severe pain and burning heat are felt at the umbilicus and 
scorbiculis cordis, and are distressing: when the skin is cold and deluged 
with cold, clammy dew, and when there are oppression of the chest and diffi- 
culty of breathing, excessive pain and confusion about the head, with great 
intolerance of light, no pulse, or a pulse scarcely to be felt, and a cadaverous 

* Diseases of India, second edition, p. 156. 



123 

smell from the body; twenty or thirty leeches should be applied immediately 
to the umbilicus and scorbiculis cordis, the calomel pill should be repeated, 
and the turpentine embrocations continued. Leeches ought likewise to be 
applied to the temples and base of the skull. 

" When the leeches bleed freely, the application of them is always attend- 
ed with decided advantage, and they should be allowed to remain till they 
have fulfilled their duty; after which a large blister or sinapism should be 
applied over the whole abdomen. Sometimes the leeches fasten but do not 
draw blood. In this case they should be removed immediately, and the 
sinapism or blister applied in their place. When the bowels are very irrita- 
ble, and constantly discharging a watery fluid, small anodyne enemas, with 
camphor, may be given, and the drogue amere, a nostrum used by the Je- 
suits, will be then found very useful in assisting the operation of calomel, 
which latter should always be repeated every two hours, till three or four 
scruples have been taken. 

" Whenever we fail in checking the disease at first, we have no resource 
but to treat urgent symptoms, and they must always be met with decision as 
they occur. The patient ought never to be left a moment without an at- 
tendant who is capable of acting according to circumstances, and who may 
take advantage of every change. 

" An opportunity sometimes offers in the advanced stage of the disease to 
abstract blood : this is indicated by a struggle or effort of the circulating sys- 
tem to overcome some resisting power, and is a most auspicious symptom, 
which should never be overlooked. This reaction indicates that the consti- 
tution is making an effort to restore the circulation, but is unable to do so till 
assisted by the abstraction of blood, which abstraction aids in removing that 
oppression which it has not power of itself to overcome. This is a point in 
the treatment of Epidemic Cholera of the greatest importance, requiring both 
tact and judgment; but the change in the circulation indicating the proprie- 
ty of adopting and the time of performing it should always be expected and 
taken advantage of as soon as it occurs. 

"In this manner the treatment proceeds, sometimes with evident signs of 
success, at others without the least impression being made upon the disease. 
A very few hours, however, will frequently develope what we ought always 
to hope for, and even to expect, viz., a favourable change. This is always 
accompanied by relief from the bowels in the form of a blackish, grey, fecu- 
lent, and tenacious discharge. Whenever this takes place there is hope, and 
the exhibition of calomel should be followed up by a smart purgative, if the 
stomach will receive it; if it will not, the enema should be administered and 
repeated till motions are procured. The purgative I have generally found to 
answer best at this stage of the disease, and to sit most lightly on the sto- 
mach, is the following draught : — 

" R pulv. jalap, comp. g ss - 
" Aq. menth. pip. 5ij. 
« M. ft. haust. ° 

" And, as it is a matter of the very first consequence to act upon the bowels 
freely as soon as possible, if this draught have no effect in two or three hours, 
it should always be repeated. 

" Urine is neither secreted nor passed during the continuance of the dis- 
ease; whenever it appears, which it frequently does, with a full and free 
discharge from the bowels, the occurrence is always favourable. 

" Twelve or eighteen hours generally terminate this disorder either one 
way or the other; but when we succeed in subduing the violence of the at- 
tack, the greatest attention and care are required to preserve the patient 
against the effects of that general disturbance which the constitution has 
suffered. 

" The subsequent treatment is now to be considered; and the indication in 
this stage is to guard against congestion in the abdominal and thoracic vis- 
cera, and in the brain, some one of wbich suffers in a greater or less degree, 
and occasionally the whole are attacked at the same time. 

" The eyes are sometimes peculiarly bright, with contracted pupils, and 



124 

there is an evident intolerance of light; yet these patients insist that they 
have no uneasiness in the head, and that they can look at the light with per- 
fect ease. 

" The pulse is often oppressed and labouring, notwithstanding a very large 
quantity of blood may have been taken during the first stage of the disease. 

" These are symptoms that require immediate attention, and, when urgent, 
blood should be taken from the arm, but, in general, leeches will answer every 
purpose, and I consider them a safer remedy in this stage of the disease than 
general bleeding, because they appear to me to empty the capillary vessels, 
and aid in regulating the circulation without destroying power — a point of 
great importance where the constitution has already suffered so severely. 

" When the patient shrinks from pressure on the abdomen, leeches should 
be placed over it in considerable numbers, and particularly in the neighbour- 
hood of the liver ; and when the head is affected, they should be applied at 
the temples and base of the skull. 

" Whilst these symptoms of oppression and congestion require the most 
minute attention, we must not lose sight of the state of the alimentary canal, 
of the secretions of the small intestines, and of the alvine discharges. 

" Though the irritability of the stomach sometimes continues till a very 
late period, yet in general it is subdued early, and that organ retains all that 
is taken, both as medicine aud nourishment; but as the small intestines ex- 
hibit, on dissection of fatal cases, a most peculiar appearance, from the duo- 
denum to the ccecum; as they are very much contracted in their diameter, 
thickened and pulpy in appearance; and as they are, when laid open, found 
filled with a cream-coloured, thick, viscid, and tenacious matter, exactly like 
old cream-cheese, which obstructs their canals; and, moreover, as this mat- 
ter is to be found in every fatal case of Cholera, so it may be inferred to exist 
in some degree even in all that recover; and therefore the removal of it must 
be a primary consideration. 

" Purgatives do not seem, however, to act upon this matter at first, for 
they merely produce watery dejections; so long, therefore, as these continue, 
we may be sure that all is not right, even although they be reported copious 
and free. The dejections should always be examined with great care; for, 
until the above described matter is brought away, I never consider that I 
have made much advancement in the cure. 

" Calomel, in scruple doses, I have always found most useful in removing 
this peculiar secretion. Sometimes I have combined the calomel with aloes, 
and continued it every night and morning, till the dejections became of a 
blackish grey colour, substantial and tenacious. The purging draught and 
the enema were then had recourse to, with the best effects. 

" This practice was followed up regularly every day with leeches, blisters, 
&c. &c, according to circumstances. In a day or two the motions were 
usually observed to become dark green, which colour always indicated an ap- 
proach to healthy action. The calomel and purging draughts were still con- 
tinued, however, five or six days longer, till the dejections became more 
natural, and a visible improvement was observed in the appearance of the 
patient. He was then put upon an alterative course of medicine for a month 
or more, according to circumstances. This latter measure is absolutely ne- 
cessary to prevent a relapse, which is very common, and always dangerous. 

" This plan of treating the Epidemic Cholera, which was adopted in the 
general hospital at Madras, under my charge, during the prevalence of that 
disease from 1819 to 1823, was attended with a success that certainly far 
exceeded my expectations." 



(F.) — Referred to page 104. 
TREATMENT OF THE CHOLERA IN PARIS. 

The subject which we approach with the greatest reluctance, (say Drs. Pen- 
nock and Gerhard, in their " Observations on the Cholera of Paris,") from the 
extreme difficulty which it offers, is that of the treatment; this difficulty de- 



125 

pends upon the little power which our remedial agents possess of opposing 
this disease, and still more the necessity of constantly varying the means 
employed, and the degree of activity in their use, according to the diversified 
stages which Cholera presents, In the diarrhoea, which may either be a pre- 
cursor of Cholera, or merely a slighter action of the morbid cause, the treat- 
ment should only differ in energy from that employed in ordinary seasons 
against a similar affection. In the mildest form th^re is no nausea or ex- 
citement of the pulse, or pain in the abdomen; the only inconvenience expe- 
rienced in the borborygmi and the liquid discharges; here the abstinence 
from food should be immediate, or the diet limited to light broths; this diet 
alone, or with a moderate dose of opium, will generally arrest the symptoms. 
The same diarrhoea assuming a severe form, has received the appellation of 
cholerine at Paris; the dejections are more frequent, and often attended 
with pain ; the pulse usually a little excited, with general feeling of uneasiness 
or vertigo. The diet should be as rigid as in the last mentioned instance, 
but the febrile excitement should be reduced by bleeding, and leeches if any 
local pain exist ; to these depletory means a warm bath may be added, pro- 
vided a bath can be placed close to the bedside of the patient, and be given 
without the slightest , the bath is usually followed by profuse perspi- 

ration, and with salutary effects, as the authors can attest from their person- 
al experience. Should the discharges be still abundant, they should be 
checked with opium, and if the mercurials possess any efficacy in changing 
the course of Cholera, theoretically we should advise their administration at 
this point, practically we know nothing of their action in this epidemic. Ex- 
ternal stimulants, as sinapisms, must be used at the discretion of the practi- 
tioner, the ordinary rules for their application directing his prescriptions. 
The symptoms combated by these means do not yet constitute the Cholera, 
they are but the prodromus, but the most useful and interesting moment for 
the practitioner is that of anticipation and prevention rather than cure, 
After the diarrhoea has continued for some time, the commencement of the 
formal Cholera is announced by the vomiting and cramps, which are not at 
first attended by the alteration of the voice, or the blueness and coldness of 
surface. The symptoms are now the most urgent, and require the most 
vigorous treatment, blood-letting is advisable if the pulse be not much de- 
pressed, and should be carried as far as the strength of the patient permit it, 
the effects of it in the cases with which we are familiar was happy ; unfortu- 
nately our number is necessarily limited, for the patient in hospitals are rare- 
ly seen at the most favourable moment for treatment. Use should be made 
of the hot, (not the warm,) bath, at 104° Fahr. as practised by M. Rostan, 
and external stimulants ; should no pain at the epigastrium exist, other than 
the colics, which are diminished by pressure, an emetic of ipecacuanha may 
be administered with great advantage. M. Andral was much pleased with 
its administration at La Pitie, and we know that during the existence of the 
Cholera at Vienna, the treatment by ipecacuanha was regarded as the most 
effectual. It may generally be given without fear for the most careful ex 
aminations have proved that the inflammatory appearance of the stomach 
was more frequently found at the termination than during the most violent 
period of the disease, and at the beginning, our object is to change by a sud 
den impression the derangement not of one but of the whole systems of or- 
gans. The cramps are most readily relieved by smart frictions, which are 
more effectual than compression by tourniquets as tried at one of the hospi- 
tals: the frietions should be kept up with perseverance until the patient is 
relieved. Should the blue cold stage come on in spite of the most vigorous 
treatment, we must not think of pursuing further the depletion; it was 
imagined that the profound prostration was due to the congestion of the inter- 
nal organs which impeded the action of the whole machine, but the attempts 
at blood-letting, which could only be performed by the aid of hot applications to 
the arms, caused a temporary flutter of the pulse, followed by a more rapid 
extinction of life. The treatment is the most simple possible, for it is not 
with the intention of curing the disease itself, but of preserving life, that we 
must stimulate; frictions with warm liniments should be almost incessant, 
and made from the extremities towards the central organs ; sinapisms to the 

Q 



126 

extremities; and particularly a liniment of ammonia and turpentine, which is 
applied along the spine by flannels impregnated with it, a hot smoothing-iron 
is then to be passed rapidly along its whole length. This application was 
employed by M. Petit, of the Hotel-Dieu, and with great advantage. Dry 
heat is preferable to moist, hence resort is had to sand-bags, hot cloths, or 
still better, to the introduction of heated air beneath the bed-clothes by a tube 
communicating with a small furnace. 

The question of internal stimulants has been much discussed, we regard 
them as improper in themselves, but sometimes their employment becomes 
necessary, but only for the immediate necessity of preserving life, and as 
soon as a moderate degree of reaction is produced, they should be disconti- 
nued. The diarrhoea in the cold stage, and that immediately preceding it, 
should be combated by opiate injections alone, or with a preparation of rha- 
tania; but if these injections succeed in their effect and are not discharged, 
their influence if continued is injurious, and tends to aid in producing the in- 
ternal congestions to which the patient is exposed by his extreme feebleness. 
The vomiting is best allayed by Seltzer water given simply, or with a mucila- 
ginous syrup, or if not extremely disagreeable to the patient, ice in substance, 
or iced water in very small portions. 



The following notice of the Cholera, at Montreal, already published in the 
newspapers, merits a place here, to complete our history of the Cholera. 

" The medical commission appointed by the sanitary committee to visit Ca- 
nada, for the purpose of making investigations concerning the epidemic dis- 
ease prevailing there, in anticipation of a more detailed report, which will 
be laid before the committee in a few days, present the following general 
conclusions they have formed as the result of their observations, which they 
flatter themselves will tend to allay the public anxiety. 

" 1st. The disease so lately an epidemic in Montreal and Quebec, and 
which now prevails in the city of New Tork, and is extending throughout 
the country, is Malignant Cholera, the same that has ravaged and spread its 
devastations over Europe, under the name of Asiatic and Spasmodic Cholera. 
"2d. That they have not been able to ascertain any positive unequivocal 
fact to justify a belief that it is a disease communicated by those affected with 
it, or is one of importation. 

"3d. That during the prevalence of the epidemic constitution or influence, a 
general predisposition exists in the whole community, from which very few 
individuals are exempt, productive of a liability to the disease. 

" 4th. That this predisposition is manifested by embarrassed and difficult 
digestion, sense of heat, fulness, uneasiness or pain in the abdomen, irregu- 
larity of bowels, a furred and pasty tongue, with frequency of cramps or 
constrictions in the muscles of the extremities, especially at night. 

" 5th. That this state of predisposition will not give rise to an attack of 
the disease, without the application of an exciting cause. 

" 6th. That the exciting causes of the disease are moral excitants, espe- 
cially fear and anger ; intemperance in the use of fermented and spirituous 
liquours, or in eating, overloading the stomach; acid drinks, or large draughts 
of cold water; the use of crude indigestible food, whether animal or vegeta- 
ble, particularly the latter ; excessive exertion or fatigue in the heat of the 
day ; exposure to the night air, sitting in currents of air, and particularly 
sleeping with too light covering, and with the windows raised, except the 
rooms are very small and confined, Most of the attacks occur in the night, 
from 11 or 12 o'clock to 3 or four in the morning. 

" 7th. That prudence in living during the epidemic period, which conti- 
nues from six weeks to three months, the wearing of flannel, particularly on 
the body, keeping the feet warm and dry, the avoidance of improper food 
and drinks, tranquillity of mind and body, are almost certain guaranties 
against the assaults of the disease, and disarm the pestilence of its malignity. 
"8th. That the disease, when abandoned to its course, passes through dif- 



121 

ferent stages, in all of which it is easily controlled, except one — the cold 
stage-., or period of collapse, and which is in almost every instance, preceded 
by the symptoms of the forming stage, when the disease, if timely treated, 
is arrested with facility. 

"9th. That the symptoms of this forming stage should be generally pro- 
mulgated, and persons instructed of the necessity of an immediate attention 
to them. It is ignorance in this respect, amongst the labouring and lower 
classes of society, and their habits of life, leading to indifference and inat- 
tention, that plunges so many, belonging to those conditions, in the despe- 
rate situation so frequently met with, when medical aid and human skill are 
utterly unavailing. Those symptoms are, a sudden looseness of the bowels, 
the discharges becoming thin, watery, and colourless, or whitish, with little 
odour — vertigo or dizziness — nausea, oppression, pain and cramps of the sto- 
mach, with retching and vomiting of a fluid, generally resembling dirty river 
water, attended or soon followed by cramps of the extremities, particularly 
of the legs and thighs. 

" 10th. When the foregoing symptoms appear, application for remedial as- 
sistance must be made immediately. The delay of an hour may usher in the 
cold stage, or period of exanimated prostration and collapse, from which it 
is almost impossible to resuscitate the expiring energies of the economy. 

" 11th. That every preparation should be made by the public authorities, 
in anticipation of the appearance of the disease, providing the means of 
treatment for those who cannot command them, so that aid may be promptly 
administered to all, the moment of attack. These means are a number of 
small hospitals, or houses of receptions, in various parts of the city; stations 
where nuises, physicians, and students, with suitable medicines and appa- 
ratus, can be procured in the night without delay, the evacuation of certain 
localities, where the occurrence of numerous cases indicates a pestiferous in- 
fluence, and the furnishing to the poor, as far as practicable, wholesome and 
nourishing food. 

By the adoption and observance of the foregoing means of precaution and 
prevention, in addition to the sanitive measures already adopted, the com- 
mission are convinced that the prevalence of the disease will be greatly cir- 
cumscribed, its mortality diminished, and the public guarded against panic 
and alarm, the great sources of danger — and under the blessing of Divine 
Providence, the pestilence will be shorn of its terrors, and mitigated in its 
destructive fury. 

SAMUEL JACKSON, 
CHAS. D. MEIGS, 
RICHARD HARLAN. 



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